Hayes v South East Coast Ambulance Service NHS Foundation Trust

Ambulance technicians treating a patient with severe or life-threatening asthma must undertake and record appropriate observations, reassess the patient after treatment, and provide treatment required by the applicable clinical guidelines. An apparent improvement, such as an ability to speak or walk, does not justify relying on that impression alone where objective assessment is absent and the patient remains at risk of deterioration. Where further treatment is indicated, failure to administer additional bronchodilator therapy, ipratropium or adrenaline may constitute negligence. Causation is ordinarily determined on the balance of probabilities. The material-contribution approach applies only where the claimant cannot establish that the breach probably caused the injury. A statutory bereavement scheme does not become incompatible with human rights principles merely because its categories are narrow.

The claimant brought proceedings for herself, her three sons and the estate of her former husband, who died after suffering a severe asthma attack while awaiting transfer to hospital by the defendant ambulance service. She alleged failures in assessment, documentation, treatment and resuscitation. Breach, causation and quantum were disputed.

The court considered whether the crew had acted to the standard required of reasonably competent ambulance technicians, whether negligent treatment had caused the death, whether the claimant would have reconciled with the deceased, and whether the absence of bereavement damages for surviving minor children engaged the Human Rights Act 1998.

1. Liability. The claim succeeded on negligence and causation. The deceased was in a life-threatening state on the crew’s arrival. The crew should have recorded appropriate observations, including pulse, respiratory rate and oxygen saturation, and should have reassessed him after the first nebuliser. His inability to speak placed him in an actual or potential life-threatening category under the clinical guidelines.
2. The court found that there had been no significant improvement. Reliance on the ability to speak or walk, without objective observations, was negligent. The crew should have administered ipratropium, further or continuous salbutamol, and adrenaline at the latest when the deceased collapsed. The failure to do so breached the duty of care.
3. The court preferred Dr Moore’s evidence on breach and Professor Empey’s evidence on causation. The combined and accumulated effect of the treatment which should have been given would probably have prevented the cardiac arrest. Applying Bolam v Friern Hospital Management Committee [1957] 1 WLR 583 and Bolitho v City and Hackney HA [1998] AC 232, the crew failed to act in accordance with a responsible body of ambulance technicians. The court found on the balance of probabilities that, but for the negligent treatment, the deceased would have survived. The alternative material-contribution analysis in Bailey v Ministry of Defence [2009] 1 WLR 1052 was therefore unnecessary, although each failure would in any event have made a material contribution.
4. Quantum. Applying the two-stage approach in Davies v Taylor [1974] AC 207, there was a significant chance of reconciliation, assessed at 90 per cent, with a 10 per cent risk that a renewed relationship would fail. The overall prospect of successful reconciliation was therefore assessed at 80 per cent.
5. The court made findings concerning dependency, funeral expenses, pain and suffering and services. It declined to make a declaration under the Human Rights Act 1998 concerning the statutory exclusion of surviving minor children from bereavement damages.

First-instance judgment. No prior decision is stated in the judgment.