Legal Updates

Darnley v Croydon Health Services NHS Trust [2018] UKSC 50

Facts:
A 26 year-old man Michael Darnley sought assistance at an Accident and Emergency (“A&E”) department in a hospital in the United Kingdom which was managed by the Croydon Health Services NHS Trust after he was struck on the head by an unknown assailant. The receptionist informed Darnley that he would have to wait up to 4-5 hours before someone could attend to him. However, the usual practice of the A&E Department was that anyone complaining of a head injury would be seen by a triage nurse within 30 minutes of arrival or as soon as possible.

Darnley decided to leave after 19 minutes as he was feeling too unwell to remain. Later, Darnley collapsed and was urgently brought back to the A&E Department and a large extra-dural haematoma was identified in his brain. He was immediately brought to the operating theatre for surgery but unfortunately suffered permanent brain damage in the form of left hemiplegia (paralysis on the left side).

Judgment:
In relation to the duty of care, the Supreme Court of the United Kingdom held the following:

1. This case fell within an established category of duty of care, the duty to take reasonable care not to cause physical injury to the patient. This duty is owed by those who run an A&E department to persons presenting themselves complaining of illness or injury and it is owed before such persons are treated. As soon as Darnley was accepted into the hospital’s system, he and the health trust entered into a relationship of patient and health provider, which is an established category in which the law imposes a duty of care.
2. The duty of care is owed by the health trust; it is not appropriate to distinguish between medical and non-medical staff. It is the NHS Trust’s duty to not provide inaccurate/ misleading information to patients, and they cannot avoid this duty by using reception staff (instead of medical staff) to provide this information.
3. The issue of whether a reasonable person could have provided correct information in such circumstances goes not to whether a duty of care should be established, but whether there had been a breach of such duty.

In relation to breach of duty, the Supreme Court’s analysis was as follows:

1. In determining the content of the duty of care, it would not be unreasonable to require receptionists to take reasonable care not to provide inaccurate/ misleading information regarding when medical assistance would likely be available, given that responding to requests for information regarding how the A&E Department normally operates is well within the job responsibility of the receptionists.
2. The standard required of such receptionists would be that of “an averagely competent and well-informed person performing the function of a receptionist at a department providing emergency medical care”.
3. In this case, the information provided was clearly incomplete and misleading. Coupled with the trial judge’s finding that it was reasonably foreseeable that a person might decide to leave if he believed it may be at least 4-5 hours before he would be seen by a doctor, this demonstrated a negligent breach of duty.

Finally, in relation to causation, the Supreme Court held that causation was established on the basis of the following key findings of fact made by the trial judge:

1. If Darnley had been told he would been seen within 30 minutes, he would have stayed in the A&E Department;
2. Darnley’s decision to leave had been in part due to the misinformation given to him;
3. It was reasonably foreseeable that a patient told he would have to wait for 4-5 hours would decide to leave; and
4. If Darnley had collapsed in the hospital, he would likely have made a near full recovery.

Based on the above, the Supreme Court held that the Croydon Health Services NHS Trust had breached their duty of care to not provide Darnley with misinformation about waiting times in the A&E Department, and that this breach had caused his subsequent injury. The Trust was held liable for damages accordingly.