Darnley v Croydon Health Services NHS Trust

A hospital is not ordinarily liable in negligence for harm resulting from a patient’s decision to leave an accident and emergency department after receiving inaccurate or incomplete information about waiting times. Although such harm may be foreseeable, the necessary proximity and fair, just and reasonable basis for imposing liability may be absent. The primary function of civilian reception staff is to obtain accurate information for clinical decision-making. Information about waiting times is a valuable courtesy, but does not necessarily create a legal duty to protect patients against the consequences of leaving. Clinical guidance prescribing a 15-minute triage target does not impose an absolute rule. The standard must be applied realistically, having regard to clinical workload and expert evidence.

The claimant attended the defendant’s accident and emergency department after being struck on the head. He was registered but left without clinical assessment after, on the judge’s findings, being told that he might have to wait four or five hours. He would have stayed had he been told that he would be seen within about 30 minutes. He later deteriorated, suffered an extradural haematoma and was left with hemiplegia.

The claim alleged negligence by reception staff in providing waiting-time information and failing to secure priority triage, and negligence by clinical staff in failing to assess him during the 19 minutes he was present. Liability only was tried. The central questions were whether there had been a breach of duty and whether the defendant was legally responsible for the consequences of the claimant leaving before assessment.

1. Clinical triage. The NICE guidance stating that patients with head injuries should be assessed within 15 minutes did not create an absolute imperative. The experts accepted that achievement could be affected by departmental activity, patient acuity and other clinical priorities, and identified 30 minutes as an appropriate longstop. The claimant’s non-assessment during the 19 minutes before he left was therefore not a breach of clinical duty. In any event, delay after his departure was not causative of his loss.
2. Priority triage. Reception staff were not required to refer the claimant urgently to the triage nurse. On the facts found, his presentation was not sufficiently striking to alert non-clinical staff to a condition requiring priority attention. The relevant standard was that of a member of the public exercising common sense.
3. Waiting-time information. The court accepted that the information given was inaccurate or incomplete and that the claimant would probably have remained and recovered if properly informed. That factual causation did not establish legal responsibility. Applying the principles in Caparo Industries plc v Dickman [1990] 2 AC 605, harm from a patient leaving was reasonably foreseeable, but reception staff were not under a duty to guard against harm caused by that decision. It was also not fair, just and reasonable to impose such liability.
4. The primary role of civilian reception staff was to complete registration accurately so that clinical decisions could be made. Waiting-time information was a helpful courtesy, but imposing damages liability for inaccurate or omitted information could encourage providers to prevent reception staff from giving any such information. The issue did not fall to be determined by the Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 test, although clinical expert evidence was relevant.
5. The claim accordingly failed. The residual injury was outside the scope of the defendant’s duty and the defendant was not liable to compensate the claimant.