Darnley v Croydon Health Services NHS Trust

An accident and emergency department owes a recognised duty to take reasonable care not to cause physical injury to a patient who has attended, supplied the requested details and entered its system. That duty extends to taking reasonable care when providing information about the likely availability of medical assistance.

The trust’s duty does not depend on whether information is given by clinical or administrative staff. The standard for a receptionist is that of an averagely competent and well-informed person performing that function. A patient’s departure does not break the chain of causation where it was a reasonably foreseeable response to misleading waiting-time information and caused the harmful delay.

The appellant attended the respondent NHS trust’s accident and emergency department after sustaining a head injury. A receptionist told him that he would have to wait up to four or five hours before somebody looked at him. She did not explain that a patient reporting a head injury would normally be assessed by a triage nurse within 30 minutes or as soon as possible. He left after 19 minutes, later collapsed and suffered permanent brain damage.

The High Court dismissed his negligence claim in [2015] EWHC 2301 (QB), although it found that accurate information would have caused him to remain and receive earlier treatment. The Court of Appeal dismissed his appeal by a majority in [2017] EWCA Civ 151, reported at [2018] QB 783. The central issues were whether the trust owed a relevant duty, whether the misinformation breached that duty and whether the appellant’s departure broke the chain of causation.

1. Appeal allowed unanimously. Lord Lloyd-Jones, with whom Lady Hale, Lord Reed, Lord Kerr and Lord Hodge agreed, held that the case fell within an established category of duty of care. A provider operating an accident and emergency department owes a patient who has attended, supplied the requested details and been booked into its system a duty to take reasonable care not to cause physical injury. There was no need to apply the foreseeability, proximity and fairness criteria afresh as though the case involved a novel duty. The duty’s scope included taking reasonable care not to give misleading information which might foreseeably cause physical injury.
2. The duty was owed by the NHS trust. Its existence and scope did not depend on whether information was supplied by clinical or administrative staff. Receptionists were the first point of contact and had been entrusted with giving information about the availability of medical assistance. Their lack of medical qualifications remained relevant to the standard expected when deciding breach.
3. The standard was that of an averagely competent and well-informed person performing the function of a receptionist in an emergency department. Receptionists could not be expected to give medical advice or precise waiting-time forecasts. They could reasonably be expected to avoid misleading patients about the department’s ordinary system. The appellant should have been informed that a patient reporting a head injury would normally be assessed by a triage nurse within 30 minutes or as soon as possible. Telling him only that he would wait up to four or five hours to see a doctor was incomplete, misleading and negligent, particularly because it was reasonably foreseeable that such information might cause a patient to leave.
4. The appellant’s unannounced departure did not break the chain of causation. The trial judge had found that accurate information would have caused him to remain, that his departure was based at least partly on the misinformation, and that departure in those circumstances was reasonably foreseeable. Had he remained, his collapse would have occurred in hospital, he would have received surgery earlier and he would have made a very near full recovery.
5. The case was remitted to the Queen’s Bench Division for the assessment of damages.

1. United Kingdom Supreme Court: The appeal was allowed unanimously. The case was remitted to the Queen’s Bench Division for assessment of damages: [2018] UKSC 50.
2. Court of Appeal: The appeal was dismissed by a majority, McCombe LJ dissenting: [2017] EWCA Civ 151; [2018] QB 783.
3. High Court, Queen’s Bench Division: HHJ Robinson dismissed the negligence claim after finding that the trust owed no relevant duty, the harm was outside the scope of any duty and the appellant’s departure broke the chain of causation: [2015] EWHC 2301 (QB).