§ GUIDE · A&E DISCHARGE

Sent home from A&E,
and then it was serious.

Being discharged from A&E and deteriorating afterwards is one of the most common patterns in medical negligence. The law is on the patient's side more than people expect, but proving that admission would have changed the outcome is the hard part.

Duty starts at

Reception

Darnley: waited

19 minutes

Pickering: stroke after

67 hours

Judgments here

4

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§ THE DUTY STARTS AT THE DESK

Wrong information from non-clinical staff can found a claim.

Darnley v Croydon Health Services NHS Trust [2018] UKSC 50 settled this. A man with a head injury was told by an A&E receptionist that he would wait four to five hours. He left after 19 minutes and collapsed at home with a bleed on the brain, an extradural haematoma, and was left with a severe permanent left hemiplegia.

The Supreme Court held the hospital owed him a duty not to give misleading information about waiting times, and that his decision to leave did not break the chain of causation. Liability was established and the case was sent back for damages to be assessed. An NHS trust's duty of care in A&E begins at the reception desk, not when a doctor first sees you.

§ THE WARNING THAT WAS MISSED

A transient episode can be the signal before the disaster.

Pickering v Cambridge University Hospitals [2022] EWHC 1171 (QB)

A woman with atrial fibrillation attended A&E with a cold, white leg. Doctors diagnosed a resolved ischaemic event and sent her home on aspirin, without heparin and without a warning about her stroke risk. She had a massive stroke 67 hours later. Breach of duty was admitted on day one of trial, and the judge accepted that anticoagulation would have prevented the clot progressing.

Arksey v Cambridge University Hospitals [2019] EWHC 1276 (QB)

A woman attended with a warning bleed from a brain aneurysm and was discharged without a CT scan. She suffered a catastrophic re-bleed the next day. She succeeded only on an admitted three-and-a-half-month delay in fitting a shunt for hydrocephalus; the principal allegation about the discharge failed on causation.

§ THE CAUSATION HURDLE

Proving the error is only half of it.

Arksey is the cautionary case. The court accepted there was a problem with the discharge but was not persuaded that admitting her would have prevented the re-bleed in time. Without that link, the main claim failed.

Shah v North West London Hospital NHS Trust [2013] EWHC 4088 (QB) went the same way for different reasons. A 37-year-old mother collapsed with leg weakness two weeks after childbirth and died from a ruptured common iliac artery. 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 was dismissed.

In both cases the tragedy was real and the claim still failed. That is why expert evidence on what would have happened with correct treatment matters as much as evidence on what went wrong.

§ WHAT HELPS A CLAIM

The record of what you told them.

  • Triage notes and the clinical record of your symptoms on arrival, which fix what the department knew.
  • Any advice you were given about when to return, and whether it was written down.
  • Imaging that was or was not requested, and the reasons recorded.
  • The timeline of your deterioration afterwards, ideally with dates, times and who you called.
  • For a discharge against advice or after a wait, what you were told about waiting times.

§ THE JUDGMENTS BEHIND THIS GUIDE

Four A&E judgments.

A Supreme Court decision on the duty at reception, one admitted breach, and two claims that failed on causation.

Claimant succeeded

Darnley v Croydon Health Services NHS Trust

[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

Phoebe Charmaine Pickering v Cambridge University Hospitals NHS Foundation Trust

[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

Arksey v Cambridge University Hospitals NHS Foundation Trust

[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

Shah v North West London Hospital NHS Trust

[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.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

Can I claim if I was sent home from A&E and got worse?

Possibly. You need to show the care fell below a reasonable standard and that correct care would have prevented the harm. Pickering v Cambridge University Hospitals succeeded on that basis; Arksey, against the same trust, failed on causation.

I left because of the wait. Does that ruin my claim?

Not necessarily. In Darnley v Croydon Health Services the claimant left after 19 minutes having been given misleading information about the wait, and the Supreme Court held that did not break the chain of causation.

Does a receptionist owe me a duty of care?

The trust does, and that duty covers information given by non-clinical staff. Darnley decided that an A&E department's duty begins at the reception desk.

What if the doctor made a reasonable decision that turned out wrong?

Then there is usually no negligence. In Shah v North West London Hospital the court found the failure to check leg pulses was not a breach of duty and would not have changed the outcome.

How long do I have to claim?

Usually three years from the treatment or from when you first knew something had gone wrong. For a death, three years from the date of death or knowledge.

Is a complaint to the hospital the same as a claim?

No. The NHS complaints process has a 12-month limit and cannot award compensation, and making a complaint does not pause the three-year limit on a claim.

§ MORE GUIDES

Plain answers to the other questions people ask.

Why claims fail →

Eleven real judgments where the claim failed, and what each one teaches about proving breach of duty, causation and loss in a medical negligence claim.

Payout examples →

UK medical negligence payout examples by claim type, typical compensation ranges, and what decides the amount. Then check your own claim free.

Fatal negligence payouts →

What compensation after a death caused by medical negligence can include: the bereavement award, dependency, funeral costs and the estate's claim.

Time limits →

The 3-year time limit for medical negligence claims, the date-of-knowledge rule, and the exceptions for children, mental capacity and fatal claims.

How long claims take →

How long medical negligence claims really take, stage by stage, using official NHS Resolution timing data — and what slows a claim down.

NHS payout data →

Official NHS Resolution figures, band by band, for 2024/25.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.