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Court rules on extent of duty of care owed by A&E receptionists

Posted: 05/12/2016

The High Court has recently considered the extent of the duty of care owed to attending patients by receptionists in accident and emergency (A&E) departments. In the first publicised case on this issue, Darnley v Croydon Health Services, the court concluded that a receptionist did not owe a duty of care to patients to provide accurate information about waiting times. It is understood that the decision is being appealed, and, if successful, this could have a significant impact on the provision of non-medical services, not just in A&E departments but also in GP practices.

In Darnley the claimant attended his local A&E department after sustaining a head injury in an assault. He booked in at reception and on his evidence had a severe headache, was feeling very drowsy and was finding it difficult to speak. Despite his symptoms, he was not seen by triage with any urgency and was advised by the receptionist that he would have a four to five hour wait before being seen. After 20 minutes, the claimant felt sufficiently unwell and unable to wait for several hours that he decided to go home.

His condition deteriorated at home and despite later calling an ambulance and undergoing surgery to drain a haematoma on the brain, he was left with significant brain injury and disability.

The parties agreed that had he been triaged in hospital within 30 minutes, which was the timescale within which triage should have occurred, the severity of his condition would have been recognised and he would have undergone investigations and surgery earlier than occurred. The case turned on whether the reception staff should have arranged a priority triage and whether they were negligent in advising the claimant that he would have to wait four to five hours to be seen.

The court accepted that it was foreseeable, considering the lengthy waiting time that the claimant was given, that he would decide to go home. It was further accepted that had he been told he would be assessed within 30 minutes, that he would have waited, and that not being seen in this timescale could result in an adverse outcome for him.

It was clear therefore that the receptionist had not managed the claimant properly and that it was foreseeable that the failures would lead to injury. The main question however was whether the reception staff owed any duty of care to the claimant and whether any liability arose from the failure to provide correct information about the waiting time.

Ultimately the court decided that it was not fair, just or reasonable to impose that duty of care and hold the hospital liable for the actions of the receptionist. It was held that provision of information about waiting times was not clinical information and there was no duty to be accurate about the information provided – even though that information might influence the actions or decisions of patients. The court also decided that there is no duty to guard patients against harm caused by them taking a decision not to wait to be seen.

Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, comments: “The court decided that no liability rests with reception staff despite accepting that patients may rely on information they provide when making decisions which could have adverse consequences for their health. It is an interesting case as on the one hand receptionists are not clinically trained, nor are they providing care. However, if they provide inaccurate information that has serious consequences, it seems unfair that there is no recourse for a claimant. If the appeal proceeds and succeeds, it is likely that clear guidance to reception staff will be required so that they do not provide any information about possible management of treatment, but simply take down the information necessary for appropriate assessments to be made by medical staff.”

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