Liverpool Women's Hospital NHS Foundation Trust v Ronayne

A secondary victim may recover only for a recognised psychiatric illness induced by the sudden and direct appreciation, by sight or sound, of an objectively horrifying event. The event must be assessed by the standards of a person of ordinary susceptibility.

A sequence in a hospital may amount to one event only where it forms an inexorable and seamless progression. A gradual realisation, informed by prior medical explanations and warnings, is instead an accumulation of assaults on the mind. Ordinary hospital equipment and the appearance of a gravely ill patient will not ordinarily be objectively horrifying unless the circumstances are exceptional.

The claimant's wife developed peritonitis and septicaemia following a negligently performed hysterectomy. Over about 24 to 36 hours, the claimant saw her deteriorate before emergency surgery and later saw her unconscious, swollen and connected to a ventilator and other medical equipment.

He claimed damages as a secondary victim, alleging psychiatric injury. In the Liverpool County Court, His Honour Judge Allan Gore QC rejected a diagnosis of post-traumatic stress disorder but found an adjustment disorder and awarded £9,165.88 inclusive of interest.

The Trust appealed. The central issue was whether the claimant's perceptions amounted to the sudden appreciation of an objectively horrifying event capable of founding secondary-victim liability.

1. Appeal allowed unanimously. Lord Justice Tomlinson held, with whom Lord Justice Beatson and Lord Justice Sullivan agreed, that the claimant's case failed at the threshold requirement of a sudden shocking event.

2. The applicable control mechanisms derived from [1992] 1 AC 310 require, among other things, recognised psychiatric illness induced by the sudden and direct perception of a horrifying event. Whether an event is horrifying is assessed objectively, by reference to a person of ordinary susceptibility. The relevant appearance must be exceptional, not merely alarming or distressing.

3. The judge had been wrong to treat the 24 to 36-hour period as a single event. Unlike the seamless progression in [2003] PIQR P16, this was a series of events. The claimant had been told of abnormal test results, the need for urgent surgery, the gravity of his wife's condition and, before the second visit, the explanation for it. Those communications conditioned his perception of what he saw.

4. The sight of the claimant's wife attached to drips and monitors, and later swollen and receiving life support, was not sudden or unexpected in that context. Nor was it objectively horrifying. Her appearance was that to be expected of a gravely ill hospital patient receiving treatment, albeit understandably alarming and distressing to her husband.

5. The court therefore did not decide whether the visual experiences, rather than the whole course of the wife's illness, caused the adjustment disorder. It expressed doubt about the trial judge's causation finding, particularly given the absence of intrusive recollections expected if the visual images had been the psychiatric trigger.

• Court of Appeal (Civil Division): The Trust's appeal was allowed in [2015] EWCA Civ 588.
• Liverpool County Court: His Honour Judge Allan Gore QC found that the claimant had suffered an adjustment disorder as a secondary victim and awarded damages.