Doctor Negligent But Hospital Not Liable LAW REPORT NOVEMBER 8 QUEEN'S BENCH DIVISION Before MR. JusTIcE NIEILD Although a hospital doctor was held to be guilty of negigence in failing to examine and treat a man who presented himself at the casualty department complaining of vomiting after drinking tea and who died six hours later of arsenical poisoning, his widow's action for damages against the hospital failed because even if the man had been admitted for treatment it was im- probable that a correct diagnosis could have been made in tirte to save his life. The Court dismissed an action by Mrs. Bessie Irene Barnett, widow and administratrix of the estate of William Patrick Barnett, deceased. of West Norwood, S.E., against the Chelsea and Kensington Hospital Management Committee arising out of his death through arsenical poisoning on January 1, 1966. Complained of heat Mr. Peter Pain, Q.C., and Mr. Stuart Shields for the widow; Mlr. John Wilmers Q.C.. and Mr. David Sullivan for the hospital management committee. Mr. Justice Nield, giving judg- ment, said that Mr. Barnett was em- ployed by the Chelsea College of Science and Technology as a night watchman. At about 5 a.m. on January 1, 1966, he and two fellow employees drank tea. Some of it came from a flask and the remainder was freshly prepared. After drinking the tea Mr. Barnett complained of the heat and within 20 minutes all three men vomited. They continued to vomit inter- mittently until 8 a.m.. when thev decided to go to St. Stephen's Hospital. Mr. Barnett drove them there in his car. There was no recep- tionist on duty and they entered the casulalty department, where they were interviewed by a staff nurse. They explained to her that they had been vomiting for three hours after drink- mig tea. During the interview Mr. Barnett lav down across sonie chairs. After some discussion the nurse telephoned the casualty doctor on duty, who said that he himself had been vomiting and instructed that the men should be told to go away and report to their own doctors. Mr. Barnett then drove his two colleagues back to the college, where he went into a telephone booth and lay down. He was seen lying down by various fellow employees during the morning, but he made no com- plaint. Finally at about 1 p.m. one of the men who had been sent away with him from the hospital saw him and, despite being told that he was all right, summoned the college doctor. As a result he was taken by ambulance to St. Stephen's Hos- pital, but found to be dead on arrival. The inference was that some per- son with murderous intent had intro- duced arsenic into the tea, At the inquest the verdict was murder by a person or persons unknown. The plaintiffs case was that the hospital should have inferred that Mr. Barnett was suffering from poisoning; that they failed to investigate or diagnose his condi- tion; and that his death was due to the hospital's negligence in failing to diagnose and treat him. The duty owed by hospitals to- wards persons admitted for treat- ment in the wvards had been described in Cassidy v. Ministry of Health ([1951] 2 K.B. 360), but the problem here was different and no authority bearing directly on it had been cited. It wvas necessary to determine the duty of those who ran a casualty department when a person presenited himself complaining of illness or injury and before he was treated or received into the hospital wards. lt wvas not a case of a casualty depart- ment which closed its doors and said that no patients could be received, The watchmen entered the depart- ment without hindrance, made their complaints to the nurse who received them and she passed on the com- plaints to a doctor who sent a message back to the nurse purporting to advise thenL In those circumstances there arose such a close and direct relationship b'etween the hospital and the watch- men that there was imposed upon the hospital a duty of care to them. Both the nurse and the doctor were Under a duty to Mr. Barnett to exer- cise that skill and care which were to be expected of persons in their position. In determining whether or not the doctor was guilty of negligence, it was necessary to decide whether he should have seen Mr. Barnett, examined him, admitted him to the ward, and treated or caused him to be treated. It was not the duty of a casualty doctor to see every caller at his department. Casualty depart- ments were sometimes misused by visitors who were already attending their own doctor and were merely looking for a second opinion. But a person who presented himself to a casualty department complaining of vomiting for three hours should un- doubtedly be seen by a doctor and failure to do so amounted to negli- gence. If the doctor had examined Mr. Barnett the provisional diagnosis would probably have been food poisoning and in all the circumstances it would have been his duty to adrnit him to the wards. The immediate purpose of admission would be for observation and further diagnosis. No real chance However, the evidence showed that arsenical poison was extremely diffi- cult to diagnose. Further tests might have led to a rejection of the pro- visional diagnosis of simPle food poisoning and a .uspicion of metallic poisoning and it might have become apparent that it was necessary to send certain specimens away for analysis to discover what poison was causing the condition. The hospital were negligent in failing to carry out those tests. It remained to consider whether or not Mr. Barnett's death was caused by the hospital's negligence or whether, as the hospital asserted. he must have died in any event. Even if he had been admitted to the wards the suspicion of potassium loss could hardly have become apparent before 12.30 p.m. The technical evidence established that when death resulted from arsenical poisoning it was brought about by tvo conditions-dehydra- tion and disturbance of the enzymc processes. In this case the principal condition was one of enzyme dis- turbance and the only method of treatment wh hich was likely to succeed was the case of the specific or anti- dote called B.A.L. Unless arsenical poisoning had been positively diagnosed B.A.L. would not be administered and the true assessment of the situation was that there was really no ohance of it being administered before Mr. Barnett died. Accordingly the plaintiff had failed to prove on a balance of probabilitics that it was the negli- gence of the hospital that caused the death. Solicitors.-W. H. Thompson; Mr. Nigel Ryland. DOCTOR NEGLIGENT BUT HOSPITAL NOT LIABLE BARNETr v. CHELSEA AND KENSINGTON HOSPITAL MANAGEMENT COMMrITEE