by Claire Long December-10-2018 in Healthcare Law
As waiting times in hospitals, clinics and GP practices increase, those with managerial responsibilities in a healthcare setting should note with interest the recent decision of the UK Supreme Court in the case of Darnley v Croydon Health Services NHS Trust (2018) UKSC 50.
The judgment, whilst not binding in Irish law, may be persuasive to an Irish court faced with a similar set of circumstances. The key conclusion to take from the judgment is that non-clinical staff (i.e. receptionists) owe patients a duty of care from the point of their arrival at the medical facility. This judgment means that in the UK, there is now precedent from the highest civil court making clear that legal claims alleging negligence can now successfully be founded upon inaccurate information supplied by a non-medical member of staff.
Facts
The Plaintiff, Mr Darnley, attended the Accident and Emergency department following an assault, during which he had been struck on the head. Mr Darnley was accompanied by a friend, and it was alleged that both men told the hospital receptionist that Mr Darnley had been hit on the head, had a headache, and was feeling unwell. The evidence of the two men, which was accepted by the judge at trial, was that they were informed by the receptionist they would have to wait for between 4 – 5 hours to be seen by a medically qualified professional, save if Mr Darnley was to collapse, in which case he would be treated as an emergency. This information was incorrect; under the system in place at the hospital at the time, Mr Darnley would in fact have been seen by a triage nurse within 30 minutes of his arrival.
Feeling unwell, Mr Darnley left the hospital 19 minutes after his arrival in the erroneous belief he would be waiting for a further 4 – 5 hours to be seen. Neither he, nor his friend, informed anyone at the hospital that he was leaving. Shortly afterwards, Mr Darnley’s condition deteriorated and an ambulance was called to return him to the hospital. Mr Darnley had in fact sustained a serious head injury and sadly suffered permanent brain damage in the form of a very disabling left hemiplegia.
Basis of Mr Darnley’s claim
Mr Darnley sued the NHS Hospital Trust, alleging breach of duty by the non-clinical staff (i.e. the receptionist) by providing him with inaccurate and misleading information as to waiting times, and also a failure to assess him for priority triage.
Background to the Supreme Court’s judgment
The Plaintiff was unsuccessful both at trial at the High Court, and on appeal to the Court of Appeal, and the Plaintiff therefore appealed to the Supreme Court, the final court of appeal in the UK for civil cases.
Judgment of the Supreme Court
The Supreme Court did not agree with the findings of the trial judge or the Court of Appeal and ruled that the NHS Trust was liable for negligence against the Plaintiff, given the misinformation offered by the receptionist, and the chain of events this piece of misinformation unfortunately triggered.
The Supreme Court highlighted that what mattered in this case was whether the duty of care owed to the Plaintiff had been breached, or not. The Supreme Court accepted that the NHS Trust clearly owed the Plaintiff a duty of care, and this duty became live as soon as the Plaintiff was booked in at the Accident and Emergency department. The Supreme Court held that the NHS Trust had a duty to ensure that patients were not provided with misinformation, and while it is not the function of reception staff to provide wider advice or information in general to patients, the hospital’s duty is not abrogated by the fact the misinformation was given by a non-clinical member of staff.
What should practitioners do differently on foot of the judgment?
Whilst this may seem an alarming judgment by those working in a healthcare setting, it would be overstating the position to claim that the judgment changes the law. What the judgment does do is explicitly state that in this case, the duty of care to this patient extended to non-clinical staff. The standard to which non-clinical staff are to be held, at least in the UK, is “that of an averagely competent and well-informed person performing the function of a receptionist at a department providing emergency medical care”. Whilst this statement is specific to the facts of the case, one could expect a similar standard of care to be applied in non-emergency settings.
As noted above, this is a UK judgment and as such it is not binding in Ireland. However, ignore it at your peril. The prudent healthcare provider should take steps to prepare for a similar approach being taken by the Irish courts. So what can be done to minimise risk?
- Non-clinical staff, such as receptionists, should be well-trained and made aware that the information they provide to patients or potential patients must be accurate and clear.
- Non-clinical staff should be made aware of this judgment by the hospitals, clinics and GP surgeries in which they work to ensure understanding of the potential severity of providing misinformation to patients.
- Hospital management and GP practice managers might also consider their own in-house policies in light of the judgment. Policies in respect of triage process, admissions and information provided to patients should be reviewed, and refresher training offered to staff.
- It should be ensured that all new, temporary or agency staff have been given the requisite training before they begin advising patients as to waiting times.
- A further level of protection may be to provide patients with written information as to triage procedures and likely waiting times on admission, and perhaps to have signage highlighting information regarding waiting times and triage processes to patients within the hospital area or GP practice waiting room.
The full text of the UK Supreme Court’s judgment is available here.
This article appeared in the Irish Medical Times, 8 March 2019.
For further information please contact Claire Long clong@hayes-solicitors.ie at Hayes solicitors.
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About the Author
Claire Long
Claire is an associate solicitor in the Healthcare team at Hayes solicitors. She specialises in defending medical negligence actions against hospitals and individual healthcare practitioners. Claire is committed to providing healthcare professionals with advice to support them through the litigation process, and dealing with claims expeditiously.