Darnley v Croydon Health Services NHS Trust

A hospital’s civilian receptionist generally owes no tortious duty to provide precise waiting-time information about when a patient will be seen by a triage nurse. Such information is ordinarily peripheral to the receptionist’s core function of admitting patients, recording details and passing them to clinical staff. Foreseeability that a patient may leave is insufficient. The court must consider proximity, whether imposing the proposed duty is fair, just and reasonable, and the scope of any assumed responsibility. Even if a duty existed, it would not ordinarily extend to injury caused by a patient leaving without notifying staff.

After suffering a head injury, the claimant attended the defendant’s accident and emergency department. A receptionist recorded his details, told him to wait, and said that he might have to wait four or five hours. He left after 19 minutes, before triage, and later suffered permanent injury.

The High Court dismissed the claim. It held that the failure to triage within 15 minutes was not a breach, that reception staff owed no duty concerning waiting-time information, and, alternatively, that the information did not cause the injury. The appeal concerned triage timing, the scope of the hospital’s duty, negligent misstatement and causation.

By a majority, the appeal was dismissed. Jackson LJ gave the leading judgment and Sales LJ agreed with the result and reasoning on the central issues. McCombe LJ dissented on the duty and causation issues.

1. Triage. The trial judge was entitled to find that the claimant was not a priority case and that failure to triage him within 19 minutes was not a breach. The NICE 15-minute target was not an inflexible legal deadline. The busy conditions, the experts’ evidence that the target might not always be achievable, and their consensus that 30 minutes represented an appropriate longstop justified the conclusion. The burden of proof had not shifted.
2. Duty of care. Under Caparo Industries PLC v Dickman & Ors [1990] 2 AC 605, foreseeability alone is insufficient. The court must consider proximity, whether it is fair, just and reasonable to impose a duty of the proposed scope, and the harm for which responsibility is assumed. There was no general duty on civilian receptionists, or the NHS trust acting through them, to provide accurate information about likely waiting times. Their core function was to admit patients, record details, direct them to wait and pass relevant information to clinical staff.
3. Waiting-time information. The majority distinguished the ambulance-service cases, including Kent v Griffiths [2001] QB 36 and Michael v Chief Constable of South Wales Police [2015] UKSC 2; [2015] AC 1732. An ambulance telephonist may provide information on which a person must decide how to obtain medical assistance. An A & E receptionist’s waiting-time information was peripheral and ordinarily a courtesy. The receptionist had not assumed responsibility for catastrophic consequences if the claimant left. It was therefore neither an actionable misstatement nor fair, just and reasonable to impose the proposed duty.
4. Alternative basis. Even if a duty had existed, its scope would not extend to injury caused by the claimant leaving without telling staff that he was going. The claim therefore also failed on scope of duty and causation, applying the approach in Rahman v Arearose [2001] QB 351.
5. Separate reasoning. Sales LJ observed that the case could be characterised as a failure to explain triage rather than a positive misstatement, but the distinction did not affect the result. He added that a receptionist might be liable for conduct affecting the core admission function, such as wrongly saying that the department was closed. McCombe LJ considered the hospital’s overall duty on these particular facts, applied Barnett v Chelsea and Kensington Hospital Management Committee [1967] QB 428, and would have allowed the appeal.

1. Court of Appeal (Civil Division) The appeal was dismissed by a majority: [2017] EWCA Civ 151.
2. High Court, Queen’s Bench Division HHJ Robinson dismissed the claimant’s negligence claim on 31 July 2015.