Professional Documents
Culture Documents
Hewer
Bryant
PAULL J.
[1969]
I cannot see that the situation in Duncan's case 1 4 was very different to the situation which constantly arises when a child is sent
to a boarding school, especially if the father is in the services and
is temporarily abroad so that the child may spend his or her holidays with relations or friends. Logically, in the way in which
Brook's case u and Duncan's case 16 were looked at, no child at a
public school would be in the custody of his father while he was
at school, or when he was staying in the holidays with a relative
or friend. Sir Joseph does not contend that this can be the law.
It follows from what I have said that in this case there can be
no question of the father's custody being terminated. It is true
that the infant was away from the home and might never return
again except for short periods. It is true that he was earning his
own living, but nothing h a d occurred which left the infant without anyone whose natural duty and natural conduct would be to
support the infant in any proper proceedings to be brought in
respect of the injuries. I find that the plaintiff has not proved
that he comes within the provisions of section 22 (2) (b) of the
Limitation Act, 1939.
Judgment for the defendant with
costs.
Solicitors: Lovell,
Wm. Easton & Sons.
14
1967
26 C ''27^
Swindon;
S. S.
15
Nov. 8
NiELD J.
-,
1 Q.B.
\
**
*^
casualty officerNegligence by casualty officerCaller complaining to nurse on duty and nurse reporting complaints to
casualty officer by telephoneCasualty officer not seeing caller
and advising by telephone that caller go homeSubsequent death
of callerPossibility of caller's death even if admitted to hospital
when complainingWhether
causation of death by negligence
established on balance of probabilities.
Burden
of proofNegligenceHospitalFailure
to examine
Whether their breach of duty caused damageWhether onus of
proof shifted.
At a hospital casualty department, provided and run by the
defendants, three fellow night-watchmen presented themselves,
complaining to a nurse on duty that they had been vomiting for
three hours after drinking tea. The nurse reported their complaints
by telephone to the duty medical casualty officer, who thereupon
instructed her to tell the men to go home to bed and call in
their own doctors. That she did. The men then left, and, about
five hours later, one of them died from poisoning by arsenic
which had been introduced into the tea; he might have died from
the poisoning even if he had been admitted to the hospital wards
and treated with all care five hours before his death.
In an action by his widow claiming that the death resulted
from the defendants' negligence in not diagnosing or treating
his condition when he presented himself at the casualty
department: :
Held, dismissing the action, (1) that, since the defendants
provided and ran the casualty department to which the deceased
presented himself complaining of illness or injury, such a close
and direct relationship existed between them and him that they
owed him a duty to exercise the skill and care to.be expected of
a nurse and medical casualty officer acting reasonably notwithstanding that he had not been treated and received into the
hospital wards (post, pp. 435E436B).
Dicta! of A. L. Smith L.J. in Le Lievre v, Gold [1893] 1 Q.B.
491, 504 and Lord Atkin in Donoghue v. Stevenson [1932] A.C.
562, 581 applied.
Cassidy V. Ministry of Health [1951] 2 K.B. 343; [1951] 1
All E.R. 574, C.A. distinguished.
(2) That the medical casualty officer was negligent in not
seeing and not examining the deceased, in not admitting him to
the wards and in not treating him or causing him to be treated
(post, pp. 437c-D, 438B); and that, accordingly, the defendants were
in breach of their duty to the deceased.
(3) But that, since he must have died of the poisoning even
if he had been admitted to the wards five hours before his death
and treated with all care, the plaintiff had failed to establish on
the balance of probabilities that the defendants' negligence had
caused the death; and that, therefore, the claim failed.
Per curiam. Casualty departments are misused from time to
time and it is not the case that a casualty officer must always see
1 Q.B. 1969.
16
429
1967
Baniett
v.
C
^jea
Kensington
Hos ital
P
Committee
430
Barnett
v.
''and*
Kensington
Moment
Committee
[1969]
the caller at his department, but apart from such cases the duty
f m e casualty officer is in general to see and examine all
patients coming to the casualty department of the hospital (post,
PP- 4 3 6 4 3 7 A )- T n e o n u s o f P r o o f remained upon the plaintiff
to show that the deceased died as a result of the defendants'
breach of dut
y <P0St> P'
438E
>-
ACTION.
**
**
1 Q.B.
A
j)
431
1967
told her that he had been at the hospital earlier, had returned
to work, and that all three had been vomiting.
Bamett
v.
The deceased did not speak but lay down, on armless chairs Chelsea
placed together, with his head resting on his hand. It was obvious Kensington
to anyone that he was feeling ill and that the other two men M 2^Sent
were also feeling ill. Weighall's medical record card at the hos- Committee
pital showed a diagnosis of gastritis.
When Weighall first told the nurse that the vomiting followed
the drinking of tea, she replied: " Tea would not cause that."
Her first impression was that the men had been drinking to excess,
and she was hesitant as to what to do. After a delay of several
minutes Weighall became angry and demanded to see a doctor.
The nurse then spoke on the telephone, saying:
" Is that [the medical casualty officer]? There are three
men complaining of vomiting after drinking tea."
The doctor replied:
" Well, I am vomiting myself and I have not been drinking. Tell them to go home and go to bed and call in their
own doctors, except Whittall, who should stay because he is
due for an X-ray later this morning."
The nurse passed that message to the three men and they all
left the hospital, Whittall having decided not to stay because no
treatment had been suggested. The deceased drove them back
to the college.
As soon as they reached the college the deceased went into
the telephone room where he lay down with a cushion under his
head. Later in the morning he was seen by a member of the
college staff sitting on a packing case close to a radiator in the
hall. At approximately 1 p.m. a doctor retained by the college
was called to see the deceased, but by the time the doctor arrived
it was too late to do anything for him. He was taken back by
ambulance to St. Stephen's Hospital and found to be dead on
arrival. The hospital records showed the date and hour of arrival
as " 2 p.m. January 1, 1966" and previous known illness as
"gastritis and nausea and vomiting for some hours previously."
The coroner's verdict was one of murder by a person or persons
unknown.
The plaintiff, Bessie Irene Barnett, widow of the deceased
and administratrix of his estate, brought this action on behalf of
the estate, herself and two dependent children against the defendants, claiming damages on the grounds that the death was due
to the negligence of the defendants by their servants or agents
432
[1969]
1967
B
Peter Pain Q.C. and Stuart Shields for the plaintiff. The
casualty department is in a hospital for the purpose of healing
casualties. A casualty officer should personally see all casualties.
As to the duty of care owed by the hospital to the deceased, see
Gold v. Essex County Council,1 per Lord Greene M.R.,2 which
was approved in Cassidy v. Ministry of Health? A hospital is
under a duty of care to see patients. The defendants were negligent in not giving any treatment at all. To turn away a dying
man was a wrongful neglect. A casualty officer should normally
see all casualties. It is not necessary to prove that treatment
would have been effective. The deceased did not die until five or
six hours after he was turned away. He should have been kept
under observation at the hospital.
John Wilmers Q.C. and David Sullivan for the defendants.
Even if the deceased had been admitted and treated in the defendants' hospital, it would have made no difference; the deceased
must have died in any event. The fact that a hospital has a
casualty ward is not an invitation to treat everyone who enters.
The duty laid down in Cassidy v. Ministry of Health3 only
applies where hospital authorities accept a patient for treatment:
see per Denning L.J.* There is no authority directly on the point.
It is accepted that the casualty officer should have seen the
deceased, but the general duty of hospitals does not arise in this
case. It is not the law that every hospital has to see every person
who turns up for treatment. Many hospitals are still run by
charities and to impose on them the burden of accepting as a patient
everyone who presents himself might endanger their continued
existence and solvency. If a hospital accepts a patient, it has to
exercise reasonable care, a duty which can be discharged by referring him to a proper person; but no hospital is under a duty to
accept a patient and take responsibility for him. On the evidence,
however, it was clear that even if the deceased had been taken
1
3
[1942] 2 K.B. 293; [1942] 2
[1951] 2 K.B. 343; [1951] 1
All E.R. 237, C.A.
All E.R. 574, C.A.
2
4
[1942] 2 K.B. 293, 302.
[1951] 2 K.B. 343, 360.
1 Q.B.
A
433
1967
into hospital, he could not have survived. [Reference was made
5
to Bolam v. Friern Hospital Management Committee. ]
Bamett
Pain Q.C. in reply. The duty of a hospital and its casualty
cheisea
department is to take proper professional care of all casualties Kensington
who present themselves. Proper investigation must be made. A Hospital
casualty department exists to deal with casualties, persons who Committee
have been subjected to accidents, i.e., any untold events causing
injuries. It was clearly the duty of the casualty officer to go
down and investigate the deceased's condition and that duty was
not discharged.
What flowed from the breach of duty? Although the burden
lay on the plaintiff to show that the damage was caused by the
wrongful act, once it was established, as it was, that the defendants
should have treated the deceased, the burden passed to them to
establish that the appropriate treatment would have failed. The
reason why there was no evidence of the cause of the deceased's
death lay in the defendants' breach of duty. A person cannot benefit from his own wrong. Proof of damage depended upon the
circumstances under which it was sustained: see the general
statement of principle of Bowen L.J. in Ratcliffe v. Evans.* The
rule as to the burden of proof was not a rigid rule to be followed
in all circumstances; regard must be taken of the nature of the
act by which the damage was done. [Reference was made to
Armory v. Delamirie7; The Ophelia8; and Goldman v. Hill.*]
Wilmers Q.C. on the cases cited in reply referred to Bonnington
Castings Ltd. v. Wardlaw.10
9
[19191 1 K.B. 443
"[1956] A.C. 613; [1956] 2
W.L.R. 707; [1956] 1 All E.R. 615,
H.L.(Sc).
'
434
[1969]
**
1 Q.B.
A
435
436
Bamett
v.
[1969]
Chelsea
Kensington
* n m v J u d 8 m e n t . there was here such a close and direct
Hospital relationship between the hospital and the watchmen that there
Management
. ,
, . , .
Committee was imposed upon the hospital a duty of care which they owed
t0 tne
NIELD J.
watchmen. Thus I have no doubt that Nurse Corbett and
the medical casualty officer were under a duty to the deceased to
exercise that skill and care which is to be expected of persons in
such positions acting reasonably, or, as it is, I think very helpfully,
put by the learned author of Winfield on Torts, 7th ed. (1963), p.
183:
" Where anyone is engaged in a transaction in which he holds
himself out as having professional skill, the law expects him
to show the average amount of competence associated with
the proper discharge of the duties of that profession, trade
or calling, and if he falls short of that and injures someone
in consequence, he is not behaving reasonably."
And the author proceeds to give a warning that the rule must
be applied with some care to see that too high a degree of skill
is not demanded, and he gives the example: " a passer-by who
renders emergency first-aid after an accident is not required to
show the skill of a qualified surgeon."
Let me say at this stage that there is no complaint against
Nurse Corbett that she failed in her duty.
There are two main questions here: Has the plaintiff established, on the balance of probabilities, (1) that the medical casualty
officer was negligent, and, if so, (2) that such negligence caused the
death of the deceased?
The first of those questions can be divided into four other
questions. (1) Should the doctor have seen the deceased? (2)
Should he have examined the deceased? (3) Should he have
admitted the deceased to the wards? And (4) should he have
treated or caused to be treated the deceased? The first two
of those four questions can be answered together.
It is not, in my judgment, the case that a casualty officer must
always see the caller at his department. Casualty departments are
misused from time to time. If the receptionist, for example,
discovers that the visitor is already attending his own doctor and
merely wants a second opinion, or if the caller has a small cut
which the nurse can perfectly well dress herself, then the
casualty officer need not be called. However, apart from such
JJ
1 Q.B.
A
_,
437
have been vomiting having drunk tea and have abdominal NlELD
pains her duty is to report it, and she should report accurately
to the doctor. The first step she should take to deal with the
matter is to take a history"and the doctor put it most
emphatically in this way"I cannot conceive that after a
history of vomiting for three hours a doctor would leave the
matter to a nurse, however experienced the nurse."
Without doubt the casualty officer should have seen and examined the deceased. His failure to do either cannot be described as
an excusable error as has been submitted. It was negligence. It is
unfortunate that he was himself at the time a tired and unwell
doctor, but there was no one else to do that which it was his duty
to do. Having examined the deceased I think the first and provisional diagnosis would have been one of food poisoning.
The third question is, should he have admitted the deceased to
the wards? It is sufficient to say that I accept Dr. Lockett's
opinion that, having regard to all the circumstances, it was the
casualty officer's duty to have admitted him.
The fourth question is, should the casualty officer have treated
the deceased or caused him to be treated? And it is the case
that, once admitted, the deceased's case could have gone to the
medical registrar or to others if such was the desire. The
immediate purpose of admission would be for observation and
diagnosis. No one who has listened to the evidence can doubt
that arsenical poisoning is extremely difficult to diagnose. Professor Camps accepted some figures put to him which were that,
out of 6,000 deaths between 1955 and 1965 from poisoning, only
five were due to arsenical poisoning. Again, that 3,000,000 or
4,000,000 people are admitted to about 5,000 hospitals in the
course of a year and only 60 were cases of arsenical poisoning or
potassium loss. I conclude that after a period of observation and
after taking the patient's blood pressure and subjecting him to
other general tests, and upon a reconsideration of the history,
in particular the fact that vomiting had occurred within 20
minutes of drinking the tea and also finding loss of fluid, the
doctor would have rejected the provisional diagnosis of food
438
Bamett
Cheisea
Kensington
Management
ommittee
NlELP J-
[1969]
[1956] A.C. 613; [1956] 2 W.L.R. 707; [1956] 1 All E.R. 615, H.L.(Sc).
1 Q.B.
A
j)
439
,
.
,
,
Management
T
principal condition is one of enzyme disturbanceas I am of the Committee
view it was herethen the only method of treatment which is
NIELD J.
likely to succeed is the use of the specific antidote which is
commonly called B.A.L. Dr. Goulding said in the course of his
evidence:
" The only way to deal with this is to use the specific B.A.L.
I see no reasonable prospect of the deceased being given
B.A.L. before the time at which he died "and at a later
point in his evidence" I feel that even if fluid loss had
been discovered death would have been caused by the enzyme
disturbance. Death might have occurred later."
I regard that evidence as very moderate, and it might be a
true assessment of the situation to say that there was no chance of
B.A.L. being administered before the death of the deceased.
For those reasons, I find that the plaintiff has failed to
establish, on the balance of probabilities, that the defendants'
negligence caused the death of the deceased.
Judgment for the defendants.
E
Solicitors: W, H. Thompson; Nigel Ryland.
1968
June 28;
J/J>1,31
Barrister-at-Law.]