A Supreme Court decision on the duty at reception, one admitted breach, and two claims that failed on causation.
Claimant succeeded
[2018] UKSC 50·2018·Appeal decision
A man with a head injury was told by an A&E receptionist he would wait four to five hours, left after 19 minutes, and collapsed at home with a brain bleed. The Supreme Court held the hospital owed him a duty not to give misleading information about waiting times and that his leaving did not break the chain of causation.
An NHS trust's duty of care in A&E starts at the reception desk, and wrong information given by non-clinical staff can found a negligence claim.
Claimant succeeded
[2022] EWHC 1171 (QB)·2022·Liability decided at trial
Ms Pickering, who had atrial fibrillation, attended A&E with a cold, white leg; doctors diagnosed a resolved ischaemic event and sent her home on aspirin without heparin or a warning about her stroke risk. She had a major stroke 67 hours later, and the court found that anticoagulation would have prevented it.
A transient blockage in a limb can signal a clot from the heart, and discharging such a patient without anticoagulation or advice was admitted to be negligent. The case turned on causation, with the court accepting expert evidence that heparin would have stopped the clot progressing.
Mixed outcome
[2019] EWHC 1276 (QB)·2019·Liability decided at trial
Mrs Arksey attended Addenbrooke's with a warning bleed from a brain aneurysm but was discharged without a CT scan and suffered a catastrophic re-bleed the next day. The court held she had not proved that admitting her would have avoided the re-bleed, though she succeeded on an admitted delay in fitting a shunt for hydrocephalus.
Proving breach of duty in A&E is only half the battle; the claimant must also show that the correct treatment would have prevented the injury in time, which failed here for the main allegation.
Claim failed
[2013] EWHC 4088 (QB)·2013·Liability and damages decided at trial
A widower and four children claimed after Mrs Shah, who had collapsed with leg weakness days after giving birth, died from an undetected arterial tear. The court found the A&E doctor's failure to check leg pulses was not negligent and would not have changed the outcome, so the claim failed.
Fatal claims need proof both that care fell below a reasonable standard and that better care would probably have saved the patient. The judgment nonetheless shows how dependency damages for a spouse and children are built up from the deceased's earnings and services.
Claimant succeeded£39,000
[2016] EWHC 330 (QB)·2016·Liability decided at trial
A woman hurt her wrist playing football and was seen at Ysbyty Gwynedd A&E in April 2009, where the doctor did not properly carry out all three standard clinical tests for a scaphoid fracture. The fracture went undiagnosed and she later needed a bone graft and further surgery; the court found the examination fell below a reasonable standard.
A&E doctors are expected to perform and record all the recognised tests for a scaphoid fracture when a wrist injury is suspected. Skipping part of the examination can amount to negligence even if the X-ray itself is not at fault.
Claimant succeeded
[2015] EWHC 293 (QB)·2015·Liability and damages decided at trial
A 68-year-old woman fell downstairs and broke her neck; the fracture was wrongly judged stable and she was got up and moving before surgery on 5 January 2011. Andrews J found her permanent paralysis was caused by the failure to operate and stabilise the spine by 29 December 2010.
Misjudging whether a spinal fracture is stable can turn a recoverable injury into permanent paralysis. The court decided causation by tracing when her neurology got worse relative to when she was mobilised.
Claim failed
[2016] EWHC 269 (QB)·2016·Liability decided at trial
A woman saw her GP and then attended the Royal Free A&E with severe headaches in June and July 2010, was not investigated for a bleed, and suffered a subarachnoid haemorrhage days later while abroad. The judge accepted that earlier small bleeds did not present with typical warning signs and found no breach by the GP, A&E doctor or triage nurse.
Headache claims against A&E succeed only if the presentation should have prompted a scan or lumbar puncture; atypical symptoms without red flags can make it very hard to prove negligence.
Claimant succeeded
[2016] EWHC 407 (QB)·2016·Liability decided at trial
A GP who fell downstairs and was found vomiting and confused was admitted to Manchester Royal Infirmary A&E at about 6.52 am in December 2007, but his CT head scan was not done until 1.12 pm. The court found the scan should have been performed by about 10 am and that the delay was negligent.
A patient with a head injury and reduced consciousness needs a CT scan urgently; an unexplained delay of several hours in A&E can amount to negligence.
Claimant succeeded
[2017] EWHC 1795 (QB)·2017·Liability decided at trial
A 53-year-old diabetic attended A&E with fever, rectal pain and urinary difficulty; a possible abscess was noted but he left before blood results and was not properly investigated. He returned two days later in septic shock and lost his lower leg, toes and fingers; the court found that proper care at the first attendance would have avoided the amputations.
Diabetic patients with fever and localised pain need prompt investigation for a source of infection. A&E is responsible for ensuring a possibly septic patient is not allowed to leave without a plan.
Claimant succeeded
[2020] EWHC 1610 (QB)·2020·Liability decided at trial
A GP suspected meningitis in a floppy, feverish toddler, gave penicillin and sent her by ambulance, but hospital doctors diagnosed viral tonsillitis and sent her home. Johnson J found the paediatricians should have recognised that the antibiotic could be masking sepsis and given IV antibiotics, which would have prevented her brain injury.
Hospital doctors must take a referring GP's findings seriously, especially where treatment already given may hide the true picture. A child sent in with suspected meningitis should not be discharged on reassurance alone.
Claim failed
[2021] EWHC 323 (QB)·2021·Liability decided at trial
A teacher with a back injury attended A&E and was referred for a routine MRI; the scan two weeks later showed a disc prolapse and she had emergency surgery but was left with permanent damage. The court found the registrar was not negligent in not suspecting cauda equina at that visit, and that her condition had not materially worsened during the delay.
Not every back-pain patient with some red-flag features must be scanned urgently; the court looks at the full picture presented at the time. Claimants must also prove the delay itself made the outcome worse.
Claim failed
[2022] EWHC 148 (QB)·2022·Liability decided at trial
A 29-year-old with sudden facial droop, speech problems and arm weakness was told by a junior A&E doctor she had migraine and was not referred to the TIA clinic, which the Trust admitted was a breach. Ritchie J found her March symptoms were in fact hemiplegic migraine, not mini-strokes, so the missed referral did not cause her later stroke.
Admitted breach of duty is not enough; the claimant must prove the correct pathway would have prevented the injury. Detailed findings about the exact sequence of symptoms decided this case.
Claim failed
[2022] EWHC 949 (QB)·2022·Liability decided at trial
A former lorry driver with a history of pulmonary embolism attended A&E and clinics in 2015 with chest pain and calf symptoms; the Trust admitted it should have done a Wells score and imaging at the first visit. The judge found he did not actually have a clot on that date and that the later reduction of his apixaban was not negligent, so the claim failed.
An admitted failure to investigate only leads to compensation if the investigation would have found something. Normal D-dimer results were decisive evidence against a missed clot.
Claimant succeeded£340,000
[2023] EWHC 2986 (KB)·2023·Liability decided at trial
The Trust admitted it missed an aortic dissection that emergency surgery would probably have cured, and settled the fatal claim for £340,000. When the widow and children later sued for psychiatric injury from witnessing the death, the Trust tried to strike that out but withdrew after discovering the earlier settlement had never been court-approved.
Fatal claims involving children need court approval of any settlement or it may not bind them. A missed aortic dissection in a chest-pain patient was accepted as negligent and fatal.
Claimant succeeded
[2026] EWHC 2294 (KB)·2026·Damages assessed at trial
An eight-year-old brought to Frimley Park Hospital in January 2018 with severe breathing difficulty was discharged the same afternoon instead of being admitted and given steroids; the next day he had a cardiac arrest and catastrophic brain injury. The Trust admitted negligence and causation and this judgment decides disputed heads of damages.
Sending a child home from A&E with signs of life-threatening asthma, rather than admitting and treating, was admitted to be negligent. Once liability is admitted the dispute moves to how care and lost earnings should be valued.
Claim failed
[2015] EWHC 2363 (QB)·2015·Liability decided at trial
A woman attending Medway Maritime Hospital A&E in March 2010 with an evolving stroke was not given aspirin promptly after she deteriorated, which the court found was negligent. The claim still failed because the evidence showed her outcome would have been the same even with aspirin.
Proving that A&E staff were negligent is not enough; the claimant must also show the negligence changed the outcome. Where the stroke was untreatable in time, the claim fails on causation.
Claimant succeeded£75,000
[2018] EWHC 3281 (QB)·2018·Liability decided at trial
Mr Bolton, 77, was brought to A&E by ambulance in respiratory failure and distress; after nebulised treatment he improved and the A&E doctor sent him home with antibiotics, without properly considering the paramedic and triage records. He collapsed at home hours later with an obstructed airway and died; the judge found he should have been admitted and awarded the agreed £75,000.
An A&E doctor must take account of the full picture, including paramedic and triage records, before discharging a patient who arrived in respiratory failure. Improvement after treatment does not make discharge safe if the underlying cause has not been identified.