Supreme Court finds NHS trust liable for misleading info provided by receptionists

An NHS trust was liable for incomplete and misleading information provided by two receptionists in its accident and emergency department, the Supreme Court has ruled, overturning a Court of Appeal majority decision.

Judges held in Darnley v Croydon Health Services NHS Trust that a man who suffered brain damage after being told he faced a lengthy wait in the A&E department was owed a duty of care and that this was not a new liability for the trust.

Michael Darnley went to the Mayday Hospital after being struck on the head in the street by an unknown assailant.

He was told by a receptionist that he facd a wait of four to five hours to be seen, despite his protests that he might be seriously injured, and so after 19 minutes left to go home as he felt unwell.

Mr Darnley that night suffered a extra-dural haematoma and was taken back to the hospital for an operation but suffered permanent brain damage.

He brought proceedings against the trust for breach of duty by reception staff concerning the information he was given about the time he would have to wait before being seen by a clinician and failure to assess him for priority triage.

The trial judge said that had Mr Darnley been told he was in fact likely to be seen in 30 minutes he would have stayed and his later collapse would have occurred within a hospital setting, where he might have undergone a successful operation.

He concluded though that the harm suffered by Mr Darnley was outside the scope of any duty or obligation owed by reception staff and that it would not be fair, just and reasonable to impose liability upon the trust for harm arising from a receptionist’s failure to tell him the correct likely waiting time to be seen by a triage nurse.

The judge also said the connection between the receptionist’s actions and the harm suffered was broken because it had been Mr Darnley’s decision to go home.

These positions were upheld in a two-to-one judgment by the Court of Appeal.

Giving a unanimous judgment in the Supreme Court, Lord Lloyd-Jones said: “I consider that the approach of the majority in the Court of Appeal to the issue of duty of care is flawed in a number of respects.”

He said Jackson LJ had said that to hold the trust responsible would create “a new head of liability for NHS health trusts”.

But Lord Lloyd-James said: “To my mind, however, the present case falls squarely within an established category of duty of care. It has long been established that such a duty is owed by those who provide and run a casualty department to persons presenting themselves complaining of illness or injury and before they are treated or received into care in the hospital’s wards.”

He said the trust had been negligent as “it is not unreasonable to require that patients in the position of the appellant should be provided on arrival…with accurate information that they would normally be seen by a triage nurse within 30 minutes”.

Telling Mr Darnley he faced wait of up to five hours was misleading and the trust chief executive had admitted had been “completely incorrect”.

“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,” Lord Lloyd-James said.

He said Mr Darnley left A&E on the basis of misinformation and had he not done so his collapse would have occurred in the hospital where immediate attention could be given.

“In these circumstances, the case that the appellant’s unannounced departure from the A&E department broke the chain of causation is simply not made out,” the judge said.

The case now returns to the Queen’s Bench Division for assessment of damages.

Mark Smulian