Mr Mike Paynter Consultant Nurse - NHS Emergency Nursing Expert Witness – Apex Health Associates firstname.lastname@example.org
Mr Paynter is an Emergency Nurse Consultant and part of the Apex Health Associates expert nursing team. Apex Health Associates is a UK wide and international nursing expert practice owned and run by nurses.
In this short paper, Mr Paynter looks at the recent ‘Darnley’ decision by the Supreme Court.
In 2010 Mr Michael Darnley, aged 26 years was the victim of an assault, he had sustained a head injury, he was taken by a friend to the Emergency Department at Mayday Hospital. When Mr Darnley arrived at the reception desk and ‘booked in’ the receptionist advised him of an approximate 4 to 5-hour wait. Mr Darnley felt unwell and decided not to wait in the waiting room and took himself home. Mr Darnley’s decision to not wait was based on the alleged ‘misleading’ advice provided by the receptionist. Mr Darnley did not wait to see the assessing clinician.
A short time later he collapsed at home and an ambulance was called. On arrival back in the emergency department his level of consciousness was reduced and his GCS was 9 out of 15. A large extradural haematoma was identified. Mr Darnley underwent neurosurgical intervention but was left with permanent brain injury and a left hemiplegia.
In 2015 proceedings were brought against the Croydon Health Services NHS Trust alleging a breach of duty on the part of the receptionists for giving incorrect and ‘misleading’ advice on the waiting time. The High Court Judge determined that the harm suffered was outside the scope of any duty of care or obligation owed by the receptionists. In addition, it was considered that as Mr Darnley had elected to not wait in the emergency department the causal connection had been broken. The claim of negligence against the Trust was rejected.
An appeal was made to the Supreme Court in June 2018. On10 October 2018 five Supreme Court justices overturned earlier judgements. It was judged that far from constituting a break in the chain of causation Mr Darnley’s decision to leave to emergency department was foreseeable and was based on misleading information from the receptionist about the waiting time to see a clinician. The trial judge stated; ‘the provision of such misleading information by a receptionist as to the time within which medical assistance might be available was negligent.’
Supreme Court Justice Lord Lloyd-Jones acknowledged that emergency departments operate in very difficult circumstances and under colossal pressure. However, Lord Lloyd-Jones concluded that ‘it is not unreasonable to require receptionists to take reasonable care not to provide misleading information as to the likely availability of medical assistance. The provision of misleading information was negligent.’
This is believed to be the first case of negligence involving Emergency Department receptionists giving misleading information.
It is not uncommon in many Emergency Departments and minor injury units for patients to selfpresent see a full waiting room or see the moving message board displaying the approximate waiting time and elect to leave. Likewise, it is not uncommon for patients to ‘book-in’ and then decide not to wait, many of these might leave prior to contact with a clinician. Traditionally these patients are recorded as ‘did not waits’. It has usually been considered that these patients are responsible for their own decisions. This ruling will understandably cause concern amongst NHS managers and lead clinicians in emergency care. It will no doubt cause an amount of anxiety with clerical and administration staff who are always the first point of contact.
The solicitor for Mr Darnley has stated ‘that despite fears expressed by hospital trusts, this will not lead to a new layer of responsibility for clerical staff or a new layer of liability for the NHS. The reception area of an Emergency Department is the first point of contact between the public and the hospital. The decision does not mean that reception staff should accurately state the precise time a patient would be seen by medically qualified staff. They must take reasonable care not to provide misleading information about the availability of assistance.’
‘The standard of care required is that of an averagely competent and well informed person performing the function of a receptionist in a department providing emergency medical care.’
Receptionists in our Emergency Departments and minor injury units do an outstanding job in sometimes very challenging circumstances they supervise the waiting room and keep clinicians informed and updated.
As a result of this ruling it would be reasonable to expect them to have a closer relationship with clinical teams when waiting times become excessive clinicians need to be aware of supporting them.
The waiting times should not be used as a subtle deterrent to encourage patients to go elsewhere, certainly not without contact with a health care professional.
Darnley (Appellant) -v- Croydon Health Services NHS Trust (Respondent)
On appeal from  EWCA Civ 151. Judgement given on 10 October 2018