Darnley v Croydon Health Services NHS Trust [2015] EWHC 2301 (QB) (31 July 2015)

The Claimant attended A&E after a head injury and was told he would wait 4-5 hours. He left after 19 minutes without being seen by clinical staff and later suffered serious brain injury. The claim against the hospital for negligence by reception staff in providing inaccurate waiting time information was dismissed.

Facts

On 17 May 2010, the Claimant was unlawfully attacked and struck on the head. Feeling unwell, he attended the Accident and Emergency Department at Mayday University Hospital, Croydon at 8:26pm. At reception, the Claimant and his friend Robert Tubman were told he would have to wait 4-5 hours before being seen. They were not informed that a triage nurse would see him within 30 minutes.

The Claimant left the hospital at 8:45pm without having been seen by any clinician. His condition deteriorated at home, an ambulance was called at approximately 9:42pm, and he was found to have an extra-dural haematoma requiring neurosurgery. He suffered a left hemiplegia as a result.

It was agreed that had the Claimant remained at hospital, he would have been treated sufficiently sooner to make an essentially full recovery.

Issues

The central issues were:

1. Breach of Duty by Reception Staff

Whether the non-clinical reception staff breached any duty of care by providing inaccurate information about waiting times and failing to prioritise the Claimant for triage.

2. Breach of Duty by Clinical Staff

Whether failure to assess the Claimant within 15 minutes (as per NICE guidelines) or during the 19 minutes he was present amounted to breach of duty.

3. Causation

Whether any breach caused the Claimant’s injuries.

Judgment

Findings of Fact

The Court found that the Claimant was told he would have to wait 4-5 hours and was not informed about being seen by a triage nurse within 30 minutes. The Court accepted that if such information had been provided, the Claimant would have waited.

The Claimant’s presentation at reception was not sufficiently alarming to non-clinical staff to trigger priority triage protocols.

NICE Guidelines

Regarding the 15-minute triage target, the experts agreed that this may not always be achievable due to departmental activity and clinical priorities, with 30 minutes being an acceptable longstop. The failure to triage within 19 minutes did not constitute breach of duty.

Reception Staff’s Duty

Applying the Caparo Industries v Dickman three-stage test (foreseeability, proximity, and whether it is fair, just and reasonable to impose liability), the Court held that whilst harm from patients leaving A&E without treatment was foreseeable, reception staff are not under a duty to guard patients against harm caused by their own decision not to wait.

The Court reasoned:

“The primary function of a civilian receptionist in an A&E department is to complete the relevant registration form so that clinical decisions can be taken by health care professionals.”

“The provision of information concerning waiting times is a courtesy that is rightly afforded to patients, and long may that courtesy continue. However, it is going too far to impose liability in damages either for failure to provide the information or to provide information that is inaccurate.”

The Court emphasised personal responsibility:

“It was the Claimant who was aware that he had been struck over the head. He knew he was in pain. He knew that ultimately he would be seen. He took the decision to leave before he had been seen. Ultimately, it is the Claimant who must take responsibility for the consequences of that decision, not the Defendant by its reception staff.”

Implications

This judgment at first instance established that NHS hospital reception staff do not owe a duty of care to provide accurate waiting time information, breach of which could give rise to damages. The Court expressed concern that imposing such liability could result in reception staff being instructed not to provide any information beyond completing registration forms.

The case highlights the boundaries of negligence liability in healthcare settings, distinguishing between clinical and non-clinical functions. It also emphasises the role of personal responsibility when patients make autonomous decisions to leave hospital before being seen.

Note: This decision was subsequently appealed.

Verdict: The claim was dismissed. The Defendant was not liable to compensate the Claimant for injuries resulting from his decision to leave the hospital before being seen by clinical staff.

Source: Darnley v Croydon Health Services NHS Trust [2015] EWHC 2301 (QB) (31 July 2015)