The High Court and Court of Appeal have recently considered
again the application of the secondary victim (SV) ‘control mechanisms’ to
claims arising from clinical negligence. Please see the previous post “Wild”
for a recap of the law.
Here, as a result of a negligently performed hysterectomy,
C’s wife developed septicaemia and peritonitis, and was readmitted. C witnessed
her condition deteriorate; she underwent further surgery and spent some weeks
in intensive care.
C brought a claim as a secondary victim on the basis of his
having witnessed two specific episodes (para[3]):
- (a) At about 5.00pm on 18 July, shortly before she underwent emergency exploratory surgery, he observed her connected to various machines, including drips, monitors etcetera;
- (b) Sometime on the following day he observed her in her post-operative condition. She was unconscious, connected to a ventilator and was being administered four types of antibiotic intravenously. Her arms, legs and face were very swollen. Pressure pads were in place to keep the blood in her legs flowing. Three years later Mr Ronayne described his wife’s then appearance to a consultant psychologist, Dr Eileen Bradbury, who gave evidence at trial, as resembling the “Michelin Man.”
The matter succeeded before HHJ Gore in Liverpool who found
that C suffered from a psychiatric illness (but rejected his case that he had
suffered PTSD). On appeal it was conceded by D that the Claimant had suffered
an Adjustment Disorder. The appeal considered (a) whether the event was “horrifying”
and (b) whether the appreciation of the event (i.e. ‘shock’) caused C’s
psychiatric illness.
Importantly the Court of Appeal said this about diagnosis: “close attention to diagnostic criteria is…
likely in this field to be of assistance in resolving what are often complex
questions of causation.”
In upholding D’s appeal the court found that there was no
‘seamless tale’ (as there was in Walters);
there was therefore no sudden appreciation of an event, but a ‘gradual
realisation’ (para [40]):
“At each stage in this sequence of events the Claimant was conditioned
for what he was about to perceive. Before first seeing his wife connected to
drips, monitors etc he knew, of course, that she was in hospital, and that that
was because she was not recovering as expected from her operation and was
running a high temperature”.
Secondly the court found that the events were not
‘horrifying’ and it is worth setting out the whole paragraph on this point as it
is an important one (on which many such cases are likely to turn):
“Both on the first occasion and on the second the appearance of the
Claimant’s wife was as would ordinarily be expected of a person in hospital in
the circumstances in which she found herself. What is required in order to
found liability is something which is exceptional in nature. On the first
occasion she was connected to monitors and drips. The reaction of most people
of ordinary robustness to that sight, given the circumstances in which she had
been taken into the A. and E. Department, and the knowledge that abnormalities
had been found, including a shadow over the lung, necessitating immediate
exploratory surgery, would surely be one of relief that the matter was in the
hands of the medical professionals, with perhaps a grateful nod to the ready
availability of modern medical equipment. The same is more or less true of her
swollen appearance on the second occasion. There is I think a danger of the
“Michelin Man” epithet acquiring a significance greater than it deserves. The
Claimant was conditioned to see someone from whom a litre of abscess had been
drained and whose life was in grave danger. The pressure pads, routine medical
equipment, no doubt contributed to the swollen appearance. I can readily accept
that the appearance of Mrs Ronayne on this occasion must have been both
alarming and distressing to the Claimant, but it was not in context exceptional
and it was not I think horrifying in the sense in which that word has been used
in the authorities. Certainly however it did not lead to a sudden violent
agitation of the mind, because the Claimant was prepared to witness a person in
a desperate condition and was moreover already extremely angry” [emphasis
added]
In this case Mrs Owers suffered a stroke which went
undiagnosed by the Defendant. Breach of duty was proven but causation was not.
Although the Judge found that the SV had suffered PTSD as a
result of D’s breach of duty, the SV
claim was dismissed because the events were not ’horrifying’. The court noted that
the bar was set high for such claims ([150]).
The SV had relied upon the following events for his claim
([126] – [128]):
… his wife was deteriorating in front of him and it was if they were
being ignored. He felt that something should be happening and his fear was that
if she deteriorated further and faster it would be too late. … By 11:30 – 12
noon C1 could make noises but not speak properly…
when they left Medway C1 could not get into the wheel chair and he
could not do it without the assistance of his father…
Later on the drive to Darent Valley Hospital she deteriorated further.
He said he could hear her choking. She could not alert him to the fact that
something was wrong because she could not move or speak. He said this was the
worst moment. He thought she was dying. He had to remove a bit of biscuit
from her mouth because she could not swallow it. She was slumped in the front
seat, seemingly lifeless and choking, with her head on one side and her eyes
wide open. She was panicking. [I find that this incident of choking did
happen. She may well not have been able to swallow something as large and hard
as a biscuit.] [emphasis added].
However the court found that:
[the events] were not “horrifying” as judged by objective standards and
by reference to persons of ordinary susceptibility. They were not wholly
exceptional. His wife was in the throes of a severe illness and C2
should have seen her admitted and looked after (irrespective of the eventual
outcome)
(footnote: I take account of the fact that C2 suffered PTSD, which is
an indicator (but not determinative) of a sudden shocking event. Also the
psychiatric evidence shows that C2 was more vulnerable than the average person
to developing PTSD.)
After the deterioration of 09:40
he not only saw a failure properly to diagnose and treat, but also the negligent
discharge of his wife who was by then, on any account, very seriously ill. In
the aftermath, which should have been avoided had the Defendants acted
non-negligently, he perfectly understandably gave her a biscuit to eat and
witnessed her choking upon it. [emphasis added]
Analysis
Both of these judgements provide helpful guidance on the
kinds of events that will be considered horrifying enough to meet the Alcock
control mechanism: ‘Ordinary’ treatment which is “expected in the circumstances” will clearly not suffice.
Perhaps one can see why Ronayne
failed, given that the primary victim was receiving treatment and simply had
the appearance that many in hospital have.
Owers
seems a very different case, with the primary and secondary victim seeking
treatment to no avail, and the SV then witnessing his wife’s very serious
deterioration and choking, in their car, to the point that he feared she would
die. That is certainly not the same as witnessing someone being treated in a
hospital bed attached to machines and wires.
However the sight of Mr Owers’ wife choking and unable to
speak was not considered to be ‘horrifying’ because it was not “wholly exceptional His wife was in the
throes of illness”. That is despite diagnosis apparently being important,
and his having suffered PTSD.
In the context of an individual suffering a stroke, those
symptoms are of course not ‘wholly exceptional’ (i.e. they are expected as a
result of the condition). However they were
sufficiently distressing to cause Mr Owers to suffer PTSD; surely most ordinary
members of the public would consider them to be exceptional things to witness.
It is difficult to see why, simply because symptoms are part
of the natural course of a condition – and despite their causing PTSD – they should
not be ‘horrifying’. On that analysis it is hard to see how any medical
condition could give rise to a secondary victim claim, as in almost all cases
the symptoms (however distressing) are not going to be ‘exceptional’ in the
context of whatever condition is suffered.
Consider two recent cases on the issue:
- Walters, where the Claimant’s condition was not said to be wholly exceptional in medical terms, (though preventable) but was horrifying for the Claimant to witness and experience. That claim succeeded. What distinguishes that from Owers?
- Wild (though perhaps producing an unfair result) is a proper application of Alcock: There was no horrifying event, only a gradual realisation. “knowledge of the death” was the cause of SV’s psychiatric illness. That claim rightly (at least in terms of the control mechanisms) failed.
Conclusion
The control mechanisms were intended to prevent limitless
claims by unrelated bystanders, and to limit claims to those caused by
witnessing horrific scenes (those with sufficient proximity). Whilst one can
understand that the event in Ronayne
was perhaps not “horrific” by objective standards, the decision in Owers, it seems to me, is too narrow a reading
of the Alcock mechanisms.
There is a circular logic in arguing that ‘expected’ symptoms
cannot be horrific: Surely all symptoms are, by definition, expected as a
result of whatever condition or injury is suffered and this would mean that no
secondary victim claims could succeed.
Whilst it seems fair to say that where a primary victim is
receiving treatment for whatever condition they are suffering, it would be
difficult for that treatment to be “horrific” (as in Ronayne) it is difficult to see why Mr Owers’ fear of his wife’s
death, witnessing her choking, and the helplessness he experienced (which
caused PTSD) was not.