Comment: Implications of Darnley vs Croydon Health Services NHS Trust
Written by By Medical Negligence Serious Injury Solicitor, Parbeen Alamgir.
The principles relating to negligence are simple – all clinical staff such as doctors, nurses and therapists owe a duty of care to any patient or visitor who attends for medical investigation or treatment.
If a person sustains an injury/damage because of that breach of duty, then a successful claim for compensation can be established.
The Supreme Court in Darnley v Croydon Health Services NHS Trust  UKSC  handed down judgment in early October 2018. Their judgment on the case was that all staff, including receptionists, must be careful not to mislead or provide false impression to a member of the public attending for medical investigations and treatment. If they do, they run the risk of being held to be negligent in doing so.
The case of Darnley v Croydon Health Services NHS Trust involved a Claimant who had suffered a head injury following an assault.
He was taken to the A&E department by his friend on 17th May 2010 and arrived at the Mayday Hospital A&E department at 20:26 hours.
He provided his details to the receptionist and told her that he had been struck on the back of the head and he thought he had a head injury.
He then told her that he was in a considerable amount of pain and that his head was hurting.
Although he would have been seen by a Triage Nurse within 30 minutes, the Claimant was advised that he would have to wait four or five hours before he was seen. He therefore decided to leave the hospital for his mother’s home around 20:45 hours, some 19 minutes later.
The Claimant’s condition deteriorated, and his family had to call an ambulance.
When he arrived at the hospital, a CT scan was performed which revealed an extradural haematoma. He was subsequently transferred to the neurosurgery department at St George’s Hospital.
By the time this took place it was far too late to prevent any serious and permanent brain damage from occurring.
The case was rejected by the High Court in 2015 and the ruling was upheld by the Court of Appeal in March 2017.
It was accepted that had he known about the Trust’s policy to offer a triage service to patients within 30 minutes, he would have stayed longer and would have had earlier surgery and made a near full recovery if he had been in the hospital.
The case provided the Supreme Court with an opportunity to re-visit the founding principles of Breach of Duty going back as far as Caparo v Dickman where the Supreme Court decided that the principles are applied to a healthcare situation where the duty is “one to take reasonable care not to cause physical injury to the patient”.
The Supreme Court decided that this applied to the Claimant’s case. He was booked into the A&E department – “he was accepted into the system and entered into a relationship with the [hospital trust] of patients and health care provider”.
The receptionist was the first point of contact with patients/visitors seeking medical assistance and therefore a health service. The duty of care of the Trust must be considered “in the round.” The Supreme Court said “…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.”
The Supreme Court concluded that “the standard required is that of an averagely competent and well-informed person performing the function of a receptionist at a department providing emergency medical care”.
In Mr Darnley’s case, the information provided to the Claimant was “incomplete and misleading… 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… the provision of such misleading information by a receptionist as to the time within which medical assistance might be available was negligent”.
The Supreme Court made it clear that this case should not be the extension of the law of negligence, merely that non-clinical staff must take reasonable care not to provide misleading information about the availability of medical assistance. It does not mean they should accurately state the precise time a patient would be seen by medically qualified staff.
However, to avoid opening up the floodgates, the court has stressed that the duty to take reasonable care ‘must be considered in the round.’
The Supreme court emphasised that the clinical staff do “operate in very difficult circumstances and this is a consideration which may well prove highly influential in many cases when assessing whether there has been a negligent breach of duty or not.”
Whilst some patients may seek to recover compensation based on the information from a non-clinical staff and therefore may result in surge of claims, we need to be mindful that this claim was one that was unusual in its nature and a careful consideration of the facts of the claim, the Trust’s policy and wider consideration of the circumstances need to be taken into account for each individual claim.
Healthcare providers who provide services for patients presenting in emergency departments, walk in centres, minor injuries unit and walk in clinics will now need to review their current procedures. They will need to carefully look at the process where they have to triage patients and ensure that patients are informed of the procedure itself, and the likely time-frame within which a triage assessment ought to take place.