The question of who has a duty of care to sick patients is one that has been explored, tested, and revised countless times by the NHS. The responsibility of medical staff to keep their charges safe has long been recognised as one of the most important agreements in British law, with failures to do so resulting in severe consequences for all involved.

In 2010, following a tragic case of misinformation which left a man paralysed, our definition of care and who owes it to the public was thrown into question once again, in a bitter legal battle which would go on to change British negligence law beyond recognition.

Micheal Darnley was assaulted by an unknown attacker on May 17, 2010. During the attack, he received a blow to the head and began to feel more and more unwell as the day went on. Concerned, he explained what had happened to his friend Robert Tubman, who offered to drive him to the hospital.

The closest A&E department was located within Mayday Hospital in Croydon, managed by the NHS Trust. When the men arrived they were directed to the reception desk. Michael explained that he had suffered a head injury and was in considerable pain, but was told by the receptionist that he would have to wait between four and five hours to be seen. Michael, who was beginning to panic, replied that he couldn’t wait that long, and felt as if he would collapse. The receptionist told him that he would be treated as an emergency if he did collapse.

The pair sat in the waiting room for around 19 minutes before Michael asked Robert to drive him to his mother’s house, where he remained for the rest of the afternoon. But at around 21.30, after several hours of pain, Michael became too distressed to remain at home, and his mother called an ambulance.

He was taken back to Mayday Hospital, where a CT scan revealed a large extradural hematoma with a marked midline shift. He was transferred to a specialist unit, where doctors rushed to perform life-saving brain surgery. Unfortunately, due to the delay in treatment, Michael was left with severe brain damage, and was permanently paralysed.

A case to answer

Furious with the way he had been treated by the A&E reception staff, Michael assembled a legal team and launched action against the NHS Trust. His lawyers argued that there was a breach of duty by the receptionist at the hospital when they told him that he was going to have to wait four to five hours to be seen. Neither receptionist on duty at the time could recall the conversation but said that normally someone with a head injury would be told a triage nurse would see them as a priority.

The High Court dismissed his claim, so Michael reached out to the Court of Appeal to challenge the decision. Again, the claim was dismissed, with judges ruling that the damage was outside the scope of any duty owed by the receptionist because they were not a medical professional. They added that there was no link between the breach of duty and the injury.

Convinced there was a case, Michael appealed to the highest court in the country, the Supreme Court. The Supreme Court allowed the appeal and sent the case to the Queen’s Bench Division for assessment of damages.

A first for the UK

The court accepted that, if given correct information about waiting times, Mr Darnley would have stayed at A&E. This would have meant that when his condition worsened he would have been seen promptly, and likely would have made a full recovery.

Lord Lloyd-Jones explained that the case fell within the established category of duty of care. It has been a long-established fact that those who provide and run a casualty department owe a duty of care to people with an injury or illness before they are treated by medical professionals. As soon as Michael was booked in by reception, he entered this relationship with staff. Judges agreed that it was irrelevant that the receptionist was not medically trained. The hospital decided to have a non-medical staff member as their first point of contact for people seeking medical assistance and providing accurate information. Responding to requests for information about the usual system of operation of the A&E department was well within the responsibility of receptionists, and the receptionist at the A&E department should have taken reasonable care not to provide misleading information regarding the availability of medical assistance. The information of a 4-5 hour wait, however, was incomplete and misleading, and the judge found that Michael could reasonably assume he was well enough to leave, considering the long wait time.

The trial judge found that had Michael been told he would be seen within 30 minutes, he would have waited, would have been seen, and been admitted. If he had collapsed at Mayday Hospital instead of at home, he would have undergone surgery earlier and would have made a nearly full recovery.

The Supreme Court ruled that the hospital was “negligent” by giving him such information, marking the case the UK’s first involving compensation for an injury caused by an A&E receptionist giving misleading information.