Spearman v Royal United Bath Hospitals NHS Foundation Trust

A hospital may owe vulnerable patients both the statutory duty under the Occupiers Liability Act 1957 and a wider common-law duty arising from the operation of its enterprise. The statutory duty concerns reasonable safety in using the premises. The common-law duty may require supervision, management of patient movement and restriction of access to dangerous areas.

Whether a patient remains a visitor depends not only on the place entered but also on the patient’s state of mind and intention. A confused patient who honestly takes a wrong route while trying to leave may remain a lawful visitor. Hospitals must identify risks to vulnerable patients through suitable risk assessments and take reasonable preventive measures. A patient whose illness prevents appreciation of danger is not contributorily negligent for failing to protect himself from it.

The claimant, a vulnerable patient suffering from the effects of a hypoglycaemic attack and a previous brain injury, was taken to the defendant hospital’s emergency department. Shortly after handover, he left unattended, passed through an unsecured door and reached a flat roof, where he climbed or fell over a barrier and suffered catastrophic injuries.

The defendant argued that the claimant had become a trespasser, that the accident was a suicide attempt, and that the hospital owed only statutory occupiers’ liability duties. The claimant contended that he remained a visitor and that the hospital owed concurrent statutory and common-law duties. The issues included breach, foreseeability, causation and contributory negligence.

1. The claim succeeded. The claimant’s conduct was not a suicide attempt. He was confused, fixated on leaving hospital and failed to appreciate the danger created by reaching the roof. His actions were consistent with an honest mistake rather than deliberate self-harm (paras [46]-[48]).
2. A patient does not become a trespasser merely because he enters a place which is not objectively authorised. State of mind and intention are relevant. A patient who mistakenly takes the wrong route while trying to leave may remain a visitor, particularly where there is no notice, lock or other indication that access is prohibited (para [56]).
3. The Occupiers Liability Act 1957 governs dangers arising from the state of premises or things done or omitted on them. It does not exclude wider common-law duties owed by a hospital to patients. The hospital’s duty included taking reasonable steps to keep vulnerable patients reasonably safe and managing their movement and access to dangerous areas (paras [57]-[61]).
4. The hospital should have carried out a suitable risk assessment addressing access by confused or vulnerable patients to the roof. It should also have secured the relevant door and removed furniture which facilitated climbing over the barrier. These omissions constituted breaches of duty (paras [62]-[64]).
5. The accident was reasonably foreseeable. The hospital should have anticipated that confused patients might enter the staircase, reach the roof and use furniture to overcome the barrier. Causation was established because a secure door would have prevented the claimant from reaching the roof (paras [65]-[71]).
6. There was no contributory negligence. The claimant’s failure to inform staff that he was leaving was not negligent, and his failure to appreciate the danger was caused by his impaired state of mind. The law does not penalise a person for failing to appreciate danger because of illness or unsoundness of mind (paras [72]-[74]).

Judgment was therefore entered for the claimant (para [75]).