§ GUIDE · BREATHING PROBLEMS MISSED

Struggling to breathe,
and sent home anyway.

Breathlessness is a symptom clinicians see every day, and most of it is minor. The judgments below are the other cases: a man in respiratory failure sent home from A&E, a GP who ordered a chest X-ray and never said so, a child with life-threatening asthma discharged the same afternoon. They show what a claim needs when a chest problem is missed.

Judgments read

5

Claimant succeeded

4 of 5

Henderson: agreed sum

£75,000

JBX: liability

Admitted

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§ BEFORE YOU GO FURTHER

For a missed chest problem claim to get anywhere, these things usually need to be true

  • Someone with breathing difficulty, a persistent cough or chest signs was seen by A&E, a GP, 111 or an ambulance crew and was sent home, not admitted or not investigated.
  • There was something to act on: oxygen levels or breathing rate on arrival, paramedic observations, a history of asthma or lung disease, a cough that had lasted weeks.
  • Admission, steroids, antibiotics or a chest X-ray that day would probably have changed the outcome, and the outcome was serious: intensive care, brain injury, or death.
  • It happened within the last three years, or you only recently learned that care fell short.

O'Brien is the other side: a high antibiotic dose that caused permanent damage was held a reasonable judgement for a worsening infection with sepsis risk. Treatment that harms is not negligence if a responsible doctor could have chosen it.

§ 01

Respiratory failure is not a discharge diagnosis.

Henderson v The Hillingdon Hospital NHS Foundation Trust [2018] EWHC 3281 (QB) concerned Mr Bolton, 77, 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 could not safely have been discharged, and entered judgment for the agreed £75,000. The lesson is that improvement after treatment does not make a discharge safe when the cause of the breathing failure has not been identified.

§ 02

A child with asthma, discharged the same afternoon.

JBX v Frimley Health NHS Foundation Trust [2026] EWHC 2294 (KB) is the most recent of these judgments. An eight-year-old was brought to Frimley Park Hospital in January 2018 with severe breathing difficulty and was discharged the same afternoon instead of being admitted and given a course of steroids. The next day he had a cardiac arrest and suffered a catastrophic brain injury.

The trust admitted negligence and causation in its letter of response, accepting that he should have been admitted and prescribed five days of steroids. The published judgment deals with the disputed heads of damages: future care, accommodation and the years of earning he has lost.

§ 03

The X-ray that was ordered but never mentioned, and the crew that did not escalate.

Shaheen v Dr Joanna Daish [2025] EWHC 3056 (KB)

A 49-year-old man saw his GP with breathlessness and a persistent cough. The GP ordered a chest X-ray on the computer system, but the judge found she never told him to go to the walk-in radiology department. He did not go, and he died. The court held he would have attended if told and was not himself at fault; causation and value were left for a later trial.

Hayes v South East Coast Ambulance Service [2015] EWHC 18 (QB)

An ambulance crew attending a man in a life-threatening asthma attack gave salbutamol and oxygen but recorded no observations and did not give the further drugs the national guidelines call for. He collapsed and died as they prepared to move him. The judge found the failures negligent and that with proper treatment he would probably have survived.

§ 04

When treatment that harms is still reasonable.

O'Brien v Guy's and St Thomas' NHS Trust [2022] EWHC 2735 (KB) is the loss. A man with end-stage kidney failure was given a single 400mg dose of the antibiotic gentamicin for a chest infection and suffered permanent damage to his balance and hearing. Damages had been agreed at £45,000 if the claim succeeded. It failed, because the judge accepted that a high dose was a reasonable choice for a worsening infection with a risk of sepsis, despite his kidney impairment.

The judgment makes two points that apply to every chest infection claim. A drug dose that causes a known side-effect is not negligent if it was a reasonable clinical judgement in the circumstances. And departing from a hospital guideline is not, by itself, proof of negligence.

§ 05

What a solicitor will look for.

  • The observations at triage: breathing rate, oxygen saturation, pulse and temperature, and any early-warning score.
  • The ambulance record, which in Henderson and Hayes contained the evidence that decided the case.
  • Whether a chest X-ray was requested, whether it was done, and what the patient was told about it.
  • The discharge advice and whether it was written down.
  • For asthma: the peak flow readings and whether steroids were given.
  • What happened in the following 24 to 72 hours, with times.

§ THE JUDGMENTS BEHIND THIS GUIDE

The five judgments behind this guide.

Four claimants succeeded, three of them after a death or a catastrophic injury within a day of being sent home. The fifth shows where a chest infection claim stops.

Claimant succeeded£75,000

Henderson v The Hillingdon Hospital NHS Foundation Trust

[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.

Claimant succeeded

JBX v Frimley Health NHS Foundation Trust

[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.

Claimant succeeded

Shaheen & Anor v Dr Joanna Daish

[2025] EWHC 3056 (KB)·2025·Liability decided at trial

A 49-year-old man saw his GP with breathlessness and a persistent cough; the GP ordered a chest X-ray on the computer system but the judge found she never told him to go to the walk-in radiology department. The court held he would have attended if told and was not himself at fault.

Ordering a test is not enough; the patient must be told clearly what to do. Courts are slow to blame patients for not chasing a test they did not know had been requested.

Claimant succeeded

Hayes v South East Coast Ambulance Service NHS Foundation Trust

[2015] EWHC 18 (QB)·2015·Liability and damages decided at trial

An ambulance crew attending a man in a life-threatening asthma attack gave salbutamol and oxygen but recorded no observations, did not give the further drugs the guidelines call for, and he collapsed and died as they prepared to move him. The judge found these failures negligent and that with proper treatment he would probably have survived, so the ambulance trust was liable to his family.

Ambulance staff must follow the national guidelines for life-threatening asthma, including objective observations and escalating drug treatment. Causation can be proved where proper treatment would have given a better-than-even chance of survival.

Claim failed

O'Brien v Guy's & St Thomas' NHS Trust

[2022] EWHC 2735 (KB)·2022·Liability decided at trial

A man with end-stage kidney failure was given a single 400mg gentamicin dose for a chest infection and suffered permanent balance and hearing damage. His sister's claim failed because the judge accepted that a high dose was a reasonable choice for a worsening infection with sepsis risk, despite his renal impairment.

A drug dose that causes known side-effects is not automatically negligent if it was a reasonable clinical judgement in the circumstances. Departing from a hospital guideline is not itself proof of negligence.

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

My GP said my chest was clear and I was admitted with pneumonia days later. Is that negligence?

Not automatically. Pneumonia can develop or be hard to hear early on. The questions are what your observations and history showed at the time, whether a competent GP would have arranged a chest X-ray or admission, and what the delay changed. Shaheen v Daish turned on a test that was ordered but never communicated.

I was sent home from A&E with a chest infection and came back two days later very ill. Can I claim?

Possibly, if the signs on the first visit should have led to admission and the delay caused lasting harm. Henderson v Hillingdon is the strongest example: a man in respiratory failure who improved after treatment and still should have been kept in. A short delay with full recovery is unlikely to be worth pursuing.

My child was sent home with an asthma attack and became critically ill.

JBX v Frimley Health is exactly that case, and the trust admitted both negligence and causation. The records of oxygen levels, breathing rate and peak flow, and whether steroids were given, are what an expert will examine.

The ambulance crew did not take my relative to hospital and they died.

Ambulance crews owe a duty to assess properly and follow the national guidelines. In Hayes v South East Coast Ambulance Service a crew that recorded no observations and did not escalate treatment in a life-threatening asthma attack was found liable for the death.

The antibiotics I was given caused permanent damage. Is that a claim?

Only if the choice or dose fell outside what a responsible doctor could have decided. In O'Brien v Guy's and St Thomas' a high gentamicin dose that caused hearing and balance damage was held to be a reasonable choice for a worsening infection, and the claim failed.

How long do I have?

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 of knowledge. For a child, three years from their eighteenth birthday.

§ MORE GUIDES

Plain answers to the other questions people ask.

Sent home from A&E →

A&E discharge claims: the duty that starts at the reception desk, missed warning signs, and the causation hurdle that decides most cases. Real judgments.

GP failure to refer →

How GP negligence claims work when symptoms are dismissed or a referral is not made: red flags, examination, scope of duty, and why some claims fail.

Child sent home →

Six published judgments on children discharged or reassured with meningitis, sepsis, asthma or infection. Four succeeded, one at £9.3 million.

Ambulance & 999 claims →

Six published judgments against ambulance services: crews who left patients at home, delays that caused harm, and treatment that fell short. Four succeeded.

Died after being sent home →

A discharge from A&E, a GP visit or a paramedic's decision that ended in a death: what four families proved, why three claims failed, how fatal claims are built.

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.