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Duty of care in Accident and Emergency

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What duties are owed to patients by reception staff in Accident and Emergency Departments?

This question was recently considered by the court in the case of Darnley v Croydon Health Services NHS Trust.

Mr D had been attacked and struck on the head.  He went to Accident and Emergency.  He said that the reception staff told him that he would be seen in 4-5 hours.   At the trial, the reception staff did not recall the incident but stated that they would have told Mr D that he would be seen by a triage nurse within 30 minutes.

Mr D, who said he believed he would not be seen for at least four hours, decided to go home without seeing any nurse or doctor in the department.   Whilst he was at home, his condition deteriorated and he suffered a left hemiplegia.

NICE Guidelines require that a patient with a head injury should be assessed by a clinician within 15 minutes of arrival at Accident and Emergency.   The court found as a matter of fact that Mr D had left the hospital 19 minutes after his arrival and that he had not been told that he would be seen within 30 minutes.  The court was satisfied that had Mr D received that information, he would have waited to be seen.  The court further found that had he remained at the hospital, he would still have been there when his condition deteriorated. He would have been properly managed and would have made a full recovery.

However, Mr D failed in his claim.   The court found that although the hospital did not assess Mr D within the 15 minute period laid down in the NICE Guidelines, the failure to comply with those guidelines by such a small margin (4 minutes – Mr D left after 19 minutes) was not a breach of the hospital’s duty of care to Mr D and in any event the breach had not caused the loss because Mr D had elected to leave the hospital and had suffered the deterioration later whilst at home.

The court went on to consider whether the hospital receptionists owed Mr D a duty to inform him that he would be seen within 30 minutes.   The court went back to first principles, considering the three part test for duty of care in Caparo Industries v Dickman (1990).

The Judge found that it was reasonably foreseeable that a patient might leave an Accident and Emergency Department without being treated, thus exposing himself to a risk of harm, if he believed that he would not be seen for several hours.   However, the receptionists were not under a duty to guard a patient from harm caused by a failure to wait to be seen.   The court concluded that it would not be fair, just or reasonable to impose a duty of care on a receptionist to give accurate information about waiting times.  The primary function of the receptionist was to complete the necessary registration form.  The provision of information about waiting times was no more than a matter of courtesy.

The court further found that if such a duty was imposed, the result might be that receptionists would confine themselves to the basic function of filling in forms and would not wish to give any information to patients.  The court therefore concluded that the receptionist owed Mr D no duty to give him information about waiting times. The receptionist was not responsible for protecting the patient from harm and it would not be fair or reasonable to impose such a duty.

The claim would in any event have failed on the basis that the link between the inadequate information given to Mr D about waiting times and the harm that he eventually suffered was broken by his decision to leave the hospital.

The problem of waiting times in the Accident and Emergency often reaches the news pages. The message for patients and people who might accompany them to Accident and Emergency is that head injuries have potentially serious but not always immediately apparent consequences, so someone who has suffered head injury should go to hospital and wait to be seen.

From the legal perspective, this first instance decision shows the court applying a cautious approach to the question of who owes a duty of care to a hospital patient, avoiding expansion of such duty to include non-clinical members of hospital staff giving information about waiting times.  It will be interesting to see whether or not this decision is appealed.

If you think you, or someone you know, may have suffered an injury as a result of negligent medical treatment and would like to speak with a member of the Lester Morrill clinical negligence team, please call on 0113 245 8549 or contact us by email at .