Liability of the A&E Receptionist
Posted by : Michael Shiers
The Court of Appeal has recently examined the duty of care owed by a non-medically qualified hospital A&E receptionist to patients in the context of a claim for compensation for medical negligence.
On Monday 17 May 2010 Michael Darnley was assaulted. He received a violent blow to the head. His friend drove him to the Accident and Emergency Department at Mayday Hospital in Croydon, South London. Mr Darnley was booked in at reception in the usual way with the receptionist taking brief personal details. Mr Darnley’s friend told the receptionist that his friend had been hit over the back of the head and he thought that he had a head injury. He was feeling very unwell and said that his head was really hurting. The evidence of the friend was that he tried to explain the significance of the injury to the receptionist to get urgent attention but she was rather dismissive. She told him that he would have to sit down and would have to wait four to five hours before somebody would look at him. Mr Darnley said that he could not wait that long because he felt he was about to collapse. Apparently, the receptionist told him that if he did collapse he would then be treated as an emergency!
What the receptionist did not tell Mr Darnley and his friend is that he would be assessed by a triage nurse usually within 15 to 30 minutes after booking in. Approximately 19 minutes after booking in, Mr Darnley was in so much pain that he decided to go home and take some pain killers. He and his friend therefore left without telling reception as they felt unable to wait the stated four to five hours. Ironically, a minute or so after they left a triage nurse tried to find the claimant but was unable to do so and so effectively therefore Mr Darnley at that point dropped out of the system.
Mr Darnley was driven to his mother’s home but approximately an hour after leaving A & E his condition did seriously deteriorate and an ambulance was called to take him back to Mayday Hospital. A subsequent CT scan showed that he had had a brain haemorrhage which tragically caused long-term brain damage.
Mr Darnley’s case was that the receptionist was negligent in telling him that he would not be seen for four to five hours. If he had been told that he would be seen within 15 to 30 minutes, he would have waited. If he had waited and been assessed by the triage nurse the seriousness of his condition would have been apparent and it is likely that he would then have received full medical treatment as a priority.
The issue for the Court was obviously a difficult one because two of the Judges came to the conclusion that Mr Darnley did not have a case and one of them did.
One Appeal Judge felt that whilst the receptionist was not medically trained in any way, it was the hospital’s overall duty which had to be assessed. In this case the hospital told Mr Darnley through the receptionist that he would receive attention in anything up to four to five hours which was incomplete and inaccurate information. The risks from head injuries were well known within the hospital and it was foreseeable that a patient may leave A & E before being seen. Therefore, the receptionist should have explained the triage system to the claimant. The failure to do so was a breach of duty on the part of the hospital.
Lord Justice Jackson however disagreed. He felt that it was not fair or reasonable to impose a duty of care on the receptionist. She did not owe any duty of care to advise about waiting times. She advised about the waiting as a matter of courtesy and should not fall foul of a claim simply because she was trying to be helpful.
The third Judge agreed saying that neither the receptionist nor the employing Hospital Trust had assumed legal responsibility for providing information as a core aspect of the service which they were asked to provide.
He felt that if this duty of care was imposed on hospitals, it would be likely to lead to defensive practices on the part of NHS Trusts such that they might forbid their receptionists to provide any information at all about waiting times which would not be a desirable result.