Non-medical staff owe a duty of care to hospital patients

On 10 October 2018, the important Supreme Court judgment in Darnley (Appellant) v Croydon Health Services NHS Trust (Respondent) [2018] UKSC 50 laid to rest any suggestion that non-medical hospital staff do not owe a duty of care to patients.

On the facts, the Appellant was wrongly advised by an A&E receptionist that he would have to wait for 4-5 hours to see a doctor. In fact, he had a head injury and would have been triaged by a triage nurse within 30 minutes. In the event, he felt too unwell to wait for 4-5 hours, left the hospital and suffered a collapse, leading ultimately to a severe and disabling brain hemiplegia. The trial judge found that if he had been told that he would be triaged within 30 minutes, he would have remained in hospital, would have suffered his collapse in hospital and would have made a full or near-full recovery.

The duty of care owed by a receptionist in A&E was characterised as follows: 

“A receptionist in an A & E department cannot, of course, be expected to give medical advice or information but he or she can be expected to take reasonable care not to provide misleading advice as to the availability of medical assistance. The standard required is that of an averagely competent and well-informed person performing the function of a receptionist at a department providing emergency medical care.

The Court made clear that “the particular role performed by the individual concerned” will be likely to have an important bearing on the questions of duty of care and breach.

In relation to the Appellant’s decision to leave the hospital, the Court found that this was reasonably foreseeable and was based at least in part on the misleading information which he had been given by the receptionist. It did not break the chain of causation.

Implications for private providers and Trusts

The practical importance of the Supreme Court’s decision cannot be underestimated. In today’s world of outsourcing and intense pressures upon hospitals, non-medical hospital staff are taking on an increasing number of responsibilities. Many of us have seen similar cases in our own practice.

A couple of years ago, I acted in a case involving a death from sepsis. The patient had attended a London A&E hospital where an untrained receptionist, employed by a private provider, had been given the function of “streaming” patients to A&E or to an Urgent Care Centre staffed by privatised GPs. At the inquest, the receptionist commented that she had “streamed” the patient to the Urgent Care Centre because she “wasn’t that sick”. The patient died the same evening. Cases like this have a way of etching themselves indelibly in your mind.

The Supreme Court’s decision is a wake-up call to private providers as well as to NHS organisations: where non-medical staff members are providing crucial functions, it is vital to ensure that they understand the importance of their role, understand their responsibilities and – above all – that they are properly trained.