Esegbona v King's College Hospital NHS Foundation Trust (false imprisonment in hospital)

A hospital is liable in negligence where it fails to pass a receiving care home specific information about a patient’s known risks, and that omission causatively contributes to the harm. General instructions do not necessarily communicate specific risks requiring enhanced supervision.

Where a patient’s capacity fluctuates, the hospital must make an adequate and continuing capacity assessment, optimise communication, involve the family in best-interests decision-making, and use the applicable deprivation-of-liberty safeguards. A hospital cannot avoid responsibility by transferring functions to commissioning or brokerage bodies.

For false imprisonment damages, the court must assess the counterfactual consequences of lawful compliance. Nominal damages are inappropriate where the lawful outcome is uncertain and proper procedures might materially have changed the patient’s detention, care or distress.

The claimant, as administrator of the estate of Christiana Esegbona, brought claims in negligence and false imprisonment against the defendant NHS Foundation Trust. Mrs Esegbona had been admitted to hospital with serious cardiac and respiratory conditions and later required a tracheostomy.

The negligence claim concerned failures to pass specific information to the nursing home about previous tube removal, obstruction, urgent suctioning, and Mrs Esegbona’s wishes. The false imprisonment claim concerned detention from February or March 2011 until discharge on 14 June 2011 without proper compliance with the Mental Capacity Act 2005.

The central issues were whether the discharge information was inadequate, whether the omissions caused or contributed to the death, when unlawful detention began, whether the defendant was the relevant decision-maker, and whether substantial or only nominal damages were recoverable.

1. Negligence and causation. The court found that the defendant failed to provide Wilsmere House with specific information about the March incidents, the risk of tube removal and obstruction, and Mrs Esegbona’s wishes. Generic references to suctioning did not communicate those particular risks. The nursing home should have provided one-to-one nursing or constant sight of a nurse. The omissions were causative because proper supervision would probably have prevented tube removal or obstruction and the resulting cardiac arrest.
2. The court rejected the contention that this was a material-contribution case. Applying the ordinary burden of proof, it held that causation was established on a but-for basis. The case was distinguishable from Bailey v Ministry of Defence [2009] 1 WLR 1052, because the competing causes were an underlying cardiac condition and removal of the tracheostomy, rather than cumulative causes of one injury.
3. False imprisonment. The defendant admitted false imprisonment but disputed its duration and damages. The court found that Mrs Esegbona was unlawfully detained from 15 February to 14 June 2011. The defendant was the relevant decision-maker while she remained in hospital. It had failed to conduct proper and ongoing capacity assessments, optimise communication, hold best-interests meetings involving the family, and make the necessary deprivation-of-liberty or Court of Protection referrals under the Mental Capacity Act 2005.
4. The analogy with Bostridge v Oxleas NHS Foundation Trust [2015] EWCA Civ 79 was rejected. Unlike that case, the lawful counterfactual was not obvious. Mrs Esegbona might have gone home, possibly on a trial basis, or might have moved to a nursing home after a proper assessment. Substantial damages were therefore appropriate.
5. Damages were awarded for false imprisonment at £15,470, aggravated damages of £5,000, and £3,500 for pain, suffering and loss of amenity. There was judgment for the claimant.