Laws of Eve | Hospital liable for misinforming patient about wait time

If you have ever wondered about the duty and standard of care that is owed to patients who visit accident and emergency departments, you should read the case of Darnley v Croydon Health Services NHS Trust [2018] UKSC 50, which was decided on October 10, 2018.

The sad background to the case (as told by the claimant) is that Darnley, a 26-year-old man, was rushed to the emergency room by a friend. He was struck on the back of the head by unknown assailants in South London. On arrival at the hospital, Darnley spoke with a receptionist, explained how he was injured, and said that he was feeling unwell and that his head was hurting. Although emphasising the need for urgent attention, Darnley and his friend were told that he would not be seen by someone for four to five hours. Darnley told the receptionist that he felt as if he was about to collapse, and the receptionist responded by saying that if he did, he would be treated as an emergency.

Neither of the two receptionists on duty at the time said that they recalled that conversation. Darnley left the emergency room after waiting 19 minutes and went to his mother's house. Within an hour, he collapsed and he was rushed to the same hospital in an ambulance. A CT Scan was done and it revealed that he had a large extra-dural haematoma overlying the left temporal lobe and inferior parietal lobe with a marked midline shift.

Permanent Brain Damage

Darnley was transferred to another hospital, where surgery was performed to evacuate the haematoma, but by then, he had suffered permanent brain damage.

Darnley sued the NHS Trust to recover damages on grounds that the staff at the hospital breached their duty concerning the information he was given about the time he would have to wait before being seen by a clinician, and also failed to assess him for priority triage. The claim was dismissed at first instance and the Court of Appeal also dismissed the appeal.

In the Supreme Court, Darnley finally succeeded, and some of the important highlights from the judgment are as follows:

"Although a receptionist in an accident and emergency department cannot be expected to give medical advice or information, he or she can be expected to take reasonable care not to provide misleading advice as to the availability of medical assistance. The standard of care is that of an averagely competent and well-informed person performing the function of a receptionist in a department providing emergency medical care."

In this case, the duty that is owed by medical and non-medical staff to patients was the same. There was no issue as to the level of skill exercised by the person who provided the information as to the wait time.

"... 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. The duty is one to take reasonable care not to cause physical injury to the patient ...".

In describing the relationship between the patient and the healthcare provider, it was further held that when Darnley attended the casualty department to seek attention for his injury, presented the requested information, and was booked in, the relationship was formed.

"... The scope of the duty to take reasonable care not to act in such a way as foreseeably to cause such a patient to sustain physical injury clearly extends to a duty to take reasonable care not to provide misleading information which may foreseeably cause physical injury." Darnley did not suffer economic loss as a result of the breach of duty to care for him, he sustained physical injury.

For all of the reasons cited above, and the fact that his decision to leave the hospital was due in part to being misinformed about the wait time, the Supreme Court allowed Darnley's appeal and remitted the case to the Queen's Bench Division for damages to be assessed.

- Sherry Ann McGregor is a partner, mediator and arbitrator in the firm of Nunes Scholefield DeLeon & Co. Please send questions and comments to lawsofeve@gmail.com or lifestyle@gleanerjm.com.