Darnley v Croydon Health Services NHS Trust [2018] UKSC 50 (10 October 2018)

Darnley v Croydon Health Services NHS Trust [2018] UKSC 50 (10 October 2018)

A was assaulted in the late afternoon of 17 May 2010 when he was struck on the head… He later telephoned his friend (F) … A told… about the assault and complained that he had a headache and that it was getting worse. F drove the appellant to the A & E department A attended at 20:26 on 17 May 2010. (paragraph 1)

[trial court accepted] A informed the receptionist that he had been assaulted by being struck over the back of the head and he thought that he had a head injury, that he was feeling very unwell and that his head was hurting. The receptionist did not have a helpful attitude and was more concerned about how the injury occurred. A and F both told the receptionist that A was really unwell and they were worried that he had a head injury and needed urgent attention. The receptionist told A that he would have to go and sit down and that he would have to wait up to four to five hours before somebody looked at him. A told the receptionist that he could not wait that long as he felt as if he was about to collapse. The receptionist replied that if the appellant did collapse he would be treated as an emergency. (paragraph 2)

…A decided to leave because he felt too unwell to remain and he wanted to go home to take some paracetamol. The judge found that A and F left after 19 minutes at 20:45. Neither informed the receptionist or told anyone else that they were leaving… (paragraph 4)

A went to bed. At about 21:30 A became distressed… An ambulance was called… A was taken by ambulance back to the A & E department… A CT scan… identified a large extra-dural haematoma overlying the left temporal lobe and inferior parietal lobe with a marked midline shift… underwent an operation for the evacuation of the haematoma. (paragraph 6)

A has suffered permanent brain damage in the form of a severe and very disabling left hemiplegia. (paragraph 7)

…The duty of the respondent trust must be considered in the round. While it is not the function of reception staff to give wider advice or information in general to patients, it is the duty of the NHS Trust to take care not to provide misinformation to patients and that duty is not avoided by the misinformation having been provided by reception staff as opposed to medical staff. In this regard, it is simply not appropriate to distinguish between medical and non-medical staff in the manner proposed by the respondent. (paragaph 19)

…The question under consideration is whether the respondent owes a duty to take reasonable care when providing, by its receptionists, information as to the period of time within which medical attention is likely to be available. More fundamentally, however, these observations are really concerned not with the existence of a duty of care but with the question whether there has been a negligent breach of duty as a result of a failure to meet the standard reasonably expected. (paragraph 21)

Responding to requests for information as to the usual system of operation of the A & E department was well within the area of responsibility of the receptionists. The two receptionists on duty at the material time were both aware that the standard procedure was that anyone complaining of a head injury would be seen by a triage nurse and they accepted that the usual practice was that such a patient would be told that they would be seen by a triage nurse within 30 minutes of arrival or as soon as possible. No reason has been suggested as to why the appellant was not told of the standard procedure. The hospital was operating within the acceptable range of triage timing agreed by the experts and the actual position was that the appellant, had he remained, would have been seen by a triage nurse within 30 minutes because he was complaining of a head injury. It is not unreasonable to require that patients in the position of A should be provided on arrival, whether orally by a receptionist, by leaflet or prominent notice, with accurate information that they would normally be seen by a triage nurse within 30 minutes. (paragraph 26)

…instead A was simply told that he would have to wait for up to four or five hours to see a doctor. That information was incomplete and misleading…. A was misinformed as to the true position and, as a result, misled as to the availability of medical assistance. The trial judge made the critical finding that it was reasonably foreseeable that a person who believes that it may be four or five hours before he will be seen by a doctor may decide to leave. In the light of that finding I have no doubt that the provision of such misleading information by a receptionist as to the time within which medical assistance might be available was negligent. (paragraph 27)

A’s decision to leave was reasonably foreseeable and was made, at least in part, on the basis of the misleading information that he would have to wait for up to four or five hours before being seen by a doctor. (paragraph 29)

I would allow the appeal and remit the case to the Queen’s Bench Division for the assessment of damages. (paragraph 31)