Supreme Court extends the reach of patient duty of care to reception staff
On Wednesday 10 October 2018, the Supreme Court unanimously allowed an appeal brought by a patient claiming damages based on false information provided to him by a hospital receptionist.
In Darnley v Croydon Health Services NHS Trust  UKSC 50 the Court held that a hospital receptionist owed a duty of care to a patient at A&E, which was breached when inaccurate information, namely that the likely waiting time for triage would be 4-5 hours when it was in fact 30 minutes, was given to Mr Darnley.
The High Court
The appellant, Michael Mark Junior Darnley, was struck on the head on 17 May 2010. A friend drove Michael to A&E at Mayday Hospital in Croydon, arriving at 20.26.
At trial, the judge found that upon reporting a head injury to the hospital receptionist, the appellant was told he would have to wait up to four to five hours before he could be seen by a clinician.
Mr Darnley told the receptionist he could not wait that long as he felt he was about to collapse. He left after 19 minutes feeling too unwell to remain. Later at his mother’s home, Darnley’s condition deteriorated and at 21:30 an ambulance was called.
Following a CT scan at Mayday Hospital, Darnley was transferred to St George’s Hospital and underwent surgery to remove a large extradural haematoma causing a marked midline. Regrettably, Mr Darnley suffered permanent brain damage from his injury
At trial, two receptionists gave evidence denying any recollection of speaking to the appellant, but each rejected the proposition that a 4-5 hour waiting time had been advised. One witness suggested that they would expect a patient presenting as Darnley did to be seen by a triage nurse within 30 minutes of arrival. The other witness said that the triage nurse would be informed and that the patient would be seen as soon as possible.
The High Court dismissed the claim.
The Court of Appeal
The appellant appealed unsuccessfully to the Court of Appeal. The Court found that neither the receptionist nor the Trust owed any duty to advise about waiting times. The Court of Appeal also assessed that the damage was outside the scope of any duty owed, and finally that there was no causal link between any breach of duty and the injury.
The appellant appealed to the Supreme Court.
The Supreme Court
In upholding the appeal the Court rejected the idea that the appellant’s case broke new ground on duty of care. In paragraph 16 Lord Lloyd Jones states:
‘… the present case falls squarely within an established category of duty of care. It has long been established that such a duty is owed by those who provide and run a casualty department to persons presenting themselves complaining of illness or injury and before they are treated or received into care in the hospital’s wards. The duty is one to take reasonable care not to cause physical injury to the patient (Barnett v Chelsea and Kensington Hospital Management Committee  1 QB 428, per Nield J at pp 435-436).’
There was no reason to undertake a full Caparo (Caparo Industries plc v Dickman  2 AC 605) analysis of whether it was fair, just and reasonable to impose a duty of care.
The scope of this duty of care extends to a duty to take reasonable care not to provide misleading information which may foreseeably cause physical injury. In assessing whether this duty has been met, it is not appropriate to distinguish between medical and non-medical staff.
The Court determined that the appellant’s decision to leave was reasonably foreseeable and was made, at least in part, on the basis of the misleading information. Had the appellant been told he would be seen within 30 minutes he would have waited, been seen by a doctor and admitted. Had, following admission, the appellant suffered the collapse at 21:30 whilst at the Mayday Hospital, he would have undergone surgery earlier and he would have made a nearly full recovery. On this factual basis the Court rejected the argument that the appellant’s departure broke the chain of causation.
This is a sobering decision where there are few positives that defendants can take from the judgment.
The Court’s determination of causation is hard to fault on these facts, but is silent on the issue of contributory negligence, a matter which may not have been aired during the appeal.
On the issue of breach the Supreme Court acknowledged the apparent absence of previous authority involving a receptionist or non-medical member of hospital staff giving rise to a negligence claim.
Michael Darnley was a patient of an NHS Trust and his injuries were reasonably foreseeable on the facts found at trial.
Critically, each case of this type will be determined on its own facts, a fact focused upon at paragraph 22 of the judgment:
‘The burden of proof of the provision of misleading information will be on the claimant… It is undoubtedly the fact that Hospital A&E departments operate in very difficult circumstances and under colossal pressure. This is a consideration which may well prove highly influential in many cases when assessing whether there has been a negligent breach of duty.’
For providers of healthcare services, Darnley is a salutary reminder that all staff, not merely medical personnel, must be properly trained and monitored.
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