Reaney v University Hospital of North Staffordshire NHS Trust & Anr  EWCA Civ 1119
Where a claimant has a pre-existing medical condition, and this is made worse by a defendant’s negligence, is the defendant liable for all the consequences of the claimant’s condition or only for making it worse? At first instance the court found North Staffordshire liable for everything. This recent decision by the Court of Appeal has revisited and clarified what had been considered a settled principal of law.
Mrs Reaney became permanently paralysed below the mid-thoracic level in 2008. Although she was an in-patient under the care of the first defendant at the time, it was common ground that this paralysis was not caused by negligence. As a result of her paralysis, Mrs Reaney endured an extended period of hospitalisation. She developed a number of pressure sores, infection of the bone marrow, hip dislocation, serious contractures of the lower limbs and increased lower limb spasticity.
North Staffordshire admitted breach of duty and that Mrs Reaney would require more care than that which she already required.
The key issue at trial was how far the pressure sores and their consequences had worsened Mrs Reaney’s position and increased her care needs. Was it that case that the defendants were liable for:
- all of Mrs Reaney’s care needs resulting from the pressure sores and their consequences; or
- those needs less the needs she would have had but for their negligence?
At first instance, Mr Justice Foskett took the first approach. This represented a marked change in the understanding of how to quantify a defendant’s liability where there was a pre-existing injury. His judgment was that the thin skull rule should be applied, and the victim should be taken as they are found.
The Court of Appeal’s decision marks a return to the law as it had previously stood. Where a claimant with a pre-existing injury is injured further, the negligent party is only liable to the extent that the injury has been worsened – and the care needs increased – by their negligence.
In this case, North Staffordshire had not injured someone fit and able, but someone who was paraplegic. The claimant failed to show that the care required as a result of their negligence was qualitatively different from her pre-existing needs.
This is a welcome restatement of the law in cases where a claimant is already suffering from a non-negligent injury. It also reaffirms that the thin-skull rule only applies where there is a pre-existing vulnerability to injury – not where that injury had already occurred. The Court of Appeal did accept that, where the negligence causes needs that are qualitatively different to the pre-existing needs, then the defendant is liable in full for those needs.
Defendants should ensure that they assess whether, in cases such as this, heads of damage are qualitatively different from those that are required for the pre-existing non-negligent injury.