The Supreme Court in Darnley v Croydon Health Services NHS Trust held an NHS trust liable for the actions of a receptionist who provided inaccurate information. The Court also reiterated that it is not necessary to apply Caparo Industries plc v Dickman in every situation.
Link to judgment:  UKSC 50
The appellant, Michael Darnley, then aged 26, was struck on the head by an unknown person on 17 May 2010 in South London. He informed his friend, Mr Tubman, about the incident over the phone and complained about having a worsening headache. Mr Tubman took him to the Accident and Emergency department at Mayday Hospital. The appellant told the receptionist about his condition, and the receptionist informed them they would need to wait 4-5 hours. After only 19 minutes the appellant left without informing the receptionist because they were not feeling well and did not want to wait that long.
The receptionists who were on duty did not recall this conversation. They nevertheless both said that usual practice for head injuries is that the patient is seen as soon as possible by a triage nurse.
Mr Tubman drove the appellant to his mother’s house where he went to bed. Later that night an ambulance was called after the appellant’s sister noted his distress. On the way he became hypertensive and projectile vomited. He arrived at the hospital at 22:38 and a CT scan identified a large extradural hematoma. Intubated and ventilated, he was shifted to St George’s hospital where he underwent an operation for the evacuation of the hematoma. The appellant suffered permanent brain damage in the form of a disabling left hemiplegia.
The appellant, Mr Darnley, brought claims against the NHS Trust. He argued that the receptionist was in breach of their duty to take reasonable care by giving inaccurate information about waiting times and failing to prioritise him for the triage system.
HHJ Robinson favored the position of the respondent; NHS Trust. He found that the NHS owed no duty of care and, in any event the receptionist would not be in breach of such a duty. On the duty question, he held that A&E Departments are not under a duty to give accurate times, and extending their duty to non-medical staff would not be fair, just and reasonable for the NHS Trust.
The trial judge further concluded the causation element was not met. If the appellant had stayed, he would have received some treatment as his condition worsened, and would have arrived at St George’s Hospital earlier. He concluded that the decision to leave the hospital was the responsibility of the claimant, and it made no difference that this was based on the estimated waiting time given by the receptionist. Therefore, this decision to leave broke the chain of causation between any alleged negligence and the claimant’s harm.
Court of Appeal
The Court of Appeal affirmed the trial judge’s decision, dismissing Mr Darnley’s appeal. They reiterated that a hospital does not owe any duty to the appellant regarding waiting times and the information given by a receptionist. In doing so, they held that such liability would not be fair, just and reasonable for the Trust. Similarly, in giving an estimated waiting time the Trust was not held to have assumed responsibility for the claimant. Sales LJ considered it an act of courtesy to give out waiting times to the patients. Furthermore, the Court of Appeal found no causal link between the harm and any breach of duty.
While dissenting the judgment, McCombe LJ found the respondent in breach of a duty of care. He disregarded the segregation of hospital functions into medical and non-medical staff. In his view, it falls under the duty of the hospital not to provide misleading information and that breach of duty was causative to the appellant’s injury.
The Supreme Court
Overturning the Court of Appeal’s decision, the Supreme Court held that the NHS Trust owed and was in breach of a duty of care which caused Mr Darnley’s loss. According to the Supreme Court, both of the lower authorities conflated or confused the issue of the existence of a duty with the question of whether the defendant breached that duty. They instead favored the dissenting comments made by McCombe LJ and found the respondent liable in the tort of negligence.
Supreme Court on Duty of Care
The Supreme Court highlighted that they were not facing a novel situation in this particular case. Instead, it fell within an established duty of care situation. Therefore, and applying the principles laid down by Lord Reed in Robinson v Chief Constable of West Yorkshire Police, the application of the Caparo factors is not applicable.
Lord Lloyd-Jones, with whom the rest of the Court agreed, concluded it is not appropriate to differentiate between medical and non-medical staff. It is the duty of the NHS to provide correct information to the patients. Therefore, it does not matter whether the information is provided by a receptionist or trained medical staff.
This conclusion was influenced by Mustill LJ’s judgment in Wilsher v Essex Area Health Authority  QB 730. In that case, he highlighted that a patient expects to receive skilled service from individuals performing any duty in a healthcare setting. Therefore, whilst a receptionist is not likely to provide medical information they do owe a duty to take reasonable care not to mislead patients.
Rather than being about the existence of a duty of care, the Supreme Court instead concluded it was about whether the Trust’s actions fell below the standards of a reasonable man. The Supreme Court Approved the case note on the Court of Appeal’s judgment by Professor James Goudkamp ( CLJ 481) where he states:
Accordingly, on traditional principles, Darnley is not, in fact, a duty of care case at all. Rather, properly understood, the issue was whether the defendant had breached its duty in giving, by its receptionist, inaccurate information to the claimant. (at p 482)
Negligent Breach of Duty
As the first point of information, a receptionist should be well aware of the pressure of working in an A&E department. Therefore, when providing information related to waiting times or the availability of medical assistance, receptionists must take reasonable care. They should not give out inaccurate or misleading information to the patients. The standard should be that of an averagely competent and well-informed receptionist performing in an emergency department.
Considering the findings of the trial judge, the Supreme Court found the receptionist was negligent in giving a 4-5 hour waiting time. The information was misleading and incomplete. Furthermore, it was reasonably foreseeable that a patient would not wait 4-5 hours for the treatment.
Based on the Trial Court’s findings, his Honor found no break in the chain of causation and favored the position of Mr Darnley.
Had the receptionist provided the correct information, the Court’s finding of fact is that he would have remained at the hospital. If he had remained at the hospital, he would have arrived and undergone surgery at St George Hospital sooner. This would have saved him from permanent brain damage.
The Courts also recognized the fact that it was reasonably foreseeable that a patient who needs emergency treatment would leave after hearing 4-5 hours of waiting time. Therefore, Lord Lloyd-Jones explained that the appellant leaving the hospital without informing anyone did not break the chain of causation.
Overturning the original ruling of the Court of Appeal, the Supreme Court therefore held that the Croydon Health Services NHS Trust had breached their duty of care causing severe injury to Mr. Darnley and should be responsible for the damages.
This was the first case in England where a receptionist in an A&E department was found negligent when providing information about waiting times, a significant wakeup call for all the healthcare providers in the UK. In doing so, the Supreme Court rejected the argument of separating medical and non-medical staff. However, this judgment places an increased responsibility on hospital staff. This means that regardless of who they are the NHS Trust is responsible if anyone fails to perform their duty.
Shifting the focus from the duty to the breach of duty
In their judgment, the Supreme Court, as the latest reaffirmation of Robinson, clarified that categories of Duty of Care should be dealt conceptually, rather than using the Caparo factors and considering its individual facts. Whilst there had been no cases of negligence by non-medical staff before, the Court considered that it did fall within an established category, and therefore the case was dealt with by analogy. In a patient and hospital setting, the duty is well defined. Relevant in this case was Kent v Griffiths  QB 36, where the London Ambulance Service was held liable for a telephone operator who negligently provided false information regarding the whereabouts of an Ambulance. The Supreme Court in Darnley therefore settled the debate regarding Public authority claims. Consequently, the proper approach when handling such cases is an incremental one, building on previous case law.
Following this, it can be said that the Supreme Court shifted the focus from the existence of a duty to whether there was a breach of that duty. This distinction, they said, should not be confused, as it had been in the lower courts. However, the impact of this decision is it places greater emphasis on the patient and represents an increased willingness to award damages if there is a negligent breach of duty. This is a big shift promoting a culture of patient autonomy but places a high burden on NHS trusts to minimize such risks in the future.
Increased burden on Hospitals and NHS Trusts
The current standard, as set by Croydon is that as soon as the patient enters the hospital, seeking medical assistance they fall under the responsibility of the hospital staff. They owe a positive duty of care to the patient and whosoever gives out information to him should be careful. Public Bodies can be held liable considering the facts of each case.
This ruling stretches the boundaries of negligence claims against hospitals to non-medical and untrained staff, adding further stress and pressure upon them. This increased burden may encourage receptionists to try to reduce interactions with patients and avoid giving information to them out of fear of giving inaccurate information. The risk, therefore, is they might adopt defensive practices, particularly while giving out information, which overall negatively impacts patients.
It is important to see the future implications of this case in clinical negligence claims. For now, it reinforces that all healthcare providers must not mislead patients, and ensure that all employees are properly trained and informed. It is however not clear how far this duty of care extends, and hospital trusts may be worried that the burden will be increased greater with further case law.