The Supreme Court, the highest Court in the UK, has just provided its Judgment on a case that could have profound implications for non-clinical NHS staff. The nub of their conclusion being that all staff, including receptionists, must be careful not to mislead or provide a false impression to a member of the public attending for medical investigation and treatment, or risk being found negligent.
It is well known that clinical staff, including nurses, doctors, therapists, owe a duty of care to patients and visitors in a healthcare environment. If a person is injured as a consequence of a breach of that duty, the injured person can be compensated.
The case of Darnley v Croydon Health Services NHS Trust [2018] UKSC 50[1] confirms that the same principles apply to non-clinical staff as well. The conclusion may cause alarm within the NHS.
Background facts of the case
The background to the case is that Mr Darnley had been assaulted. A friend drove him to A&E at the Mayday Hospital. Mr Darnley provided his personal details and 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 A&E receptionist told Mr Darnley that he would have to wait up to four to five hours before somebody looked at him. Mr Darnley told the receptionist that he could not wait that long as he felt as if he was about to collapse. Mr Darnley decided to leave because he felt too unwell to remain (for the length of time stated by the receptionist) and he wanted to go home to take some paracetamol. Unfortunately, he was subsequently taken back to the same A&E department by ambulance. Mr Darnley suffered permanent brain damage.
Duty of care
The Supreme Court revisited the principles whereby a duty of care is owed (starting with the case of Caparo v Dickman [1990]). The Court decided that when those principles are applied to a healthcare situation the duty is “one to take reasonable care not to cause physical injury to the patient”.
There was a duty of care because Mr Darnley was ‘booked in’ at the A&E Department and “he was accepted into the system and entered into a relationship with the [hospital trust] of patient and health care provider.”
The Court stated that the Hospital had charged its non-medically qualified staff with the role of being the first point of contact with persons seeking medical assistance and, as a result, with the responsibility for providing accurate information as to its availability.
This is because what is being provided is a health service, and the duty of care of the Trust must be considered ‘in the round’. They also said that “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 Court stated 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”.
Negligence (breach of duty of care)
In Mr Darnley’s case:
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 [Mr Darnley] was not told of the standard procedure … instead [Mr Darnley] 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 … 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.
Causation of Injury
Causation of Injury: The Court went on to conclude that had Mr Darnley been told that he would be seen within 30 minutes by a triage nurse; he would have stayed in the waiting area and would have been seen before he left. He would then have been admitted or told to wait. He would have waited and his later collapse would have occurred within a hospital setting. This would have meant he would have undergone surgery earlier and would have made a very near full recovery.
Compensation
Consequently, as a result of negligently provided misleading information Mr Darnley was entitled to be compensated for his injuries.
A limit to new claims?
With one eye on the possibility that some patients may seek to be compensated based on information from other non-clinical staff the Court noted that “Hospital A & E departments operate in very difficult circumstances and under colossal pressure. This is a consideration which may well prove highly influential in many cases when assessing whether there has been a negligent breach of duty.”
Conclusion
Mr Darnley suffered catastrophic injuries because he chose to leave hospital early, partially because he had been (negligently) mis-informed about the waiting time, was vulnerable following a blow to the head, and had a cognizant witness to his conversation with the receptionist. As a consequence he will be compensated for his injuries.
The Supreme Court decided that this case is an extension of the known duty on healthcare providers to take reasonable care. However, they stated that duty “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”, thus avoiding opening the flood-gates to future claims.