Mr Justice Green gave judgment today in the case of Mulholland v Medway NHS Foundation Trust [2015] EWHC 268 (QB).  Laura Johnson, instructed by Bevan Brittan LLP, London, successfully defended the Trust in a case which was concerned with the standard of care owed by Emergency Department staff.  The full judgment text is attached. 

Green J considered the nature of the obligations owed by nursing staff at triage when streaming patients to the appropriate care pathway and also the standard of care owed by doctors when treating patients in the Emergency Department who present with unclear symptoms complicated by illicit drug use.  Green J addresses wider questions of importance, including the extent to which doctors in A&E are entitled to rely upon assessments by other specialists who have examined patients and when it is appropriate for patients to be discharged from Hospital without a certain diagnosis, but with advice for community follow up. 

In 2010, unbeknownst to him, C was suffering from the effects of a brain tumour.  He was also a habitual cannabis smoker.  He attended at the Hospital by ambulance on two consecutive days in January 2010 complaining of a range of symptoms.  On the first occasion he was streamed at triage to the Same Day Treatment Centre where he was assessed by a GP and discharged.  On the second occasion he was seen by the stroke team who discharged him back to A&E for further assessment.  He was seen by an Emergency Department doctor who assessed him, advised him that his symptoms might be explained by his cannabis use, but to stop smoking cannabis and to see his GP if his symptoms persisted.  C did in fact attend his GP and continued to do so over the following months complaining of worsening symptoms. In August 2010 his tumour was discovered. 

C’s case was that both the nurse who streamed him on day one and the Emergency Department doctor who saw him on day two were in breach of duty. It was said that he should have been treated as though he had had a suspected Transient Ischaemic Attack.  Had this been done he would eventually have received a CT scan and the tumour would have been discovered several months earlier than in fact occurred.

This analysis was rejected by Green J who found for D on all aspects of breach of duty.  He also dismissed C’s case on causation on all but a very narrow ground that had been conceded by the Trust.

Full Judgment is attached here