Landmark Supreme Court judgment rules healthcare receptionists can be liable for providing misleading information which may cause injury

The Supreme Court today delivered a landmark unanimous judgment in the case of Michael Darnley v Croydon Health Services NHS Trust which will have repercussions throughout the health service (judgment here).

Facts

In May 2010 Mr Darnley suffered a head injury in an assault and attended Croydon Health Services NHS Trust’s Mayday Hospital. It was accepted by the trial judge that he was told by the A&E receptionist on arrival that he would be seen by a clinician within four to five hours.

As he felt too unwell to remain, Mr Darnley left the hospital after 19 minutes not knowing that a triage nurse would examine him within 30 minutes of arrival. His condition subsequently got worse, and by the time he returned to hospital by ambulance it was sadly too late to prevent permanent brain damage.

Mr Darnley alleged a breach of duty by the reception staff concerning the information he was given about the time he would have to wait.

Both the High Court and Court of Appeal dismissed the claim on the grounds that neither the receptionist nor the health trust acting by the receptionist owed any duty to advise about waiting times, the damage was outside the scope of any duty owed, and there was no causal link between any breach of duty and the injury.

Supreme Court Judgment

The Supreme Court unanimously allowed Mr. Darnley’s appeal, holding:

  1. The case falls squarely within an established category of duty of care: it has long been established that such a duty is owed to patients by those who provide and run a casualty department. The duty is to take reasonable care not to cause physical injury to the patient. In the present case, as soon as Mr Darnley was ‘booked in’ at reception he entered into a relationship with the Trust of patient and healthcare provider. The scope of this duty of care extends to a duty to take reasonable care not to provide misleading information which may foreseeably cause physical injury.
  2. The duty of care is owed by the Trust and it is not appropriate to distinguish, in this regard, between medical and non-medical staff. The respondent had charged its non-medically qualified staff with the role of being the first point of contact for persons seeking medical assistance and, as a result, with the responsibility for providing accurate information as to its availability.
  3. Observations on the social cost of imposing such a duty of care are misplaced as this is not a new head of liability for NHS health trusts and, in any event, the undesirable consequences of imposing the duty in question were considerably overstated. The Court did, however, acknowledge that the very difficult circumstances under which A&E departments operate “may well prove highly influential in many cases when assessing whether there has been a negligent breach of duty”
  4. It was negligent of the receptionist to inform Mr. Darnley that he would have to wait for up to 4 to 5 hours before being seen by a doctor, in the circumstances that the receptionists knew that the correct information was that he could expect to be seen by a triage nurse within 30 minutes.
  5. Mr Darnley’s decision to leave was reasonably foreseeable and was made, at least in part, on the basis of the misleading information. The trial judge had already found that had Mr Darnley been told he would be seen within 30 minutes he would have waited, been seen by a doctor and admitted, and the inpatient treatment would have led to a nearly full recovery. Thus, the fact Mr Darnley had walked out of A&E did not break the chain of causation and causation was established.

Analysis

This is the first case in England where an A&E receptionist has been found negligent for giving inaccurate information about waiting times to a patient. The Supreme Court has made it clear that the status of an employee of an organisation is not relevant to whether the organisation owes a duty of care (as distinct from the status of that employee being a factor to take into account when considering whether there has been a breach of that duty). Non-medical staff such as receptionists can make an organisation liable if misleading information is provided leading to injury. This is likely to mainly affect A&E/Urgent Care but has repercussions for all healthcare providers, including primary care.

It is hoped that this will not lead to receptionists being told to say nothing to patients apart from asking for details. Information they give is often helpful to patients. The Supreme Court specifically stated that it is not suggested that A&E receptionists have to provide detailed, up to the minute information about exact waiting times – that is simply not possible. General information about triage and waiting times is fine as long as it is reasonably accurate and not misleading. That might entail, as the court suggested, the use of leaflets or notices.

Healthcare providers need to ensure both medical and non-medical staff who interact with patients take steps to ensure patients are provided with reasonably accurate information about waiting times including information about when medical assistance is likely to be available. It now may have legal consequences if it is misleading.