According to the NHS Trust’s defence team in the case of Macaulay v Karim and Croydon Health services NHS Trust, the Trust staff should not be held responsible for any injury suffered by a patient who  voluntarily leaves an A&E department before being treated.

The judge rejected this, taking the view that their legal argument was an attempt to extend the principal established in the case of Darnley v Croydon Health services NHS Trust beyond its intended ambit.

Macaulay case

The case involved a claim for compensation after Mr Macaulay lost a leg and fingers due to a flesh-eating bug, arising from the Mayday Hospital’s delay in taking blood tests which would have diagnosed a serious underlying infection and would have led to him being admitted and having timely treatment. Instead he left the hospital without having had any treatment or investigations.

Darnley case

In the case of Darnley, the issues were in relation to the extent of the duty of care owed by receptionists in an A&E setting and whether the extent of that duty included the giving of correct information and not incorrect information about hospital waiting times. In other words it related to the role of the administrative staff as opposed to clinical staff.

In the case of Macaulay, the claimant was already "in the system" when the alleged negligence occurred. It was argued in that case and accepted by the judge that there was a failure on the part of the clinical staff to carry out blood tests in a timely way. In those circumstances the claimant would have remained in the A&E department. On balance the blood test would have revealed abnormalities and the claimant would have been admitted.

As a result of the failure of the system the claimant was not given the opportunity to make an informed decision about whether to wait. The problem arose because of the deficiency in respect of the clinical/nursing part of the system and not because of some breach on the part of the reception A&E staff as in the case of Darnley.

Deborah Blythe, partner and head of the clinical negligence and personal injury team, who acted for Mr Darnley, commented “The arguments put forward by the defendant in the Macaulay case are a warning as to how the defendants might expand the ambit of the decision of Darnley to situations where a patient leaves A&E before being treated or investigated.

Mr Darnley has just been granted permission to appeal to the Supreme Court in respect of the decision made by the Court of Appeal. The hearing should take place some time in 2018.”