At last, a common sense approach to application of NICE guidelines

At last, a common sense approach to application of NICE guidelines

​The recently decided case of Darnley v Croydon Healthcare Services & NHST, will come as a welcome relief for those medical professionals who have been on the receiving end of a clinical negligence claim, in which they have been blamed for not adhering to NICE (or any other guidelines/protocols) guidelines.

NICE (National Institute for Care and Health Excellence) publish guidelines for healthcare professionals, which provides guidance on how various medical conditions should be treated e.g. there are various guidelines for the treatment of different types of cancers which advise GPs, for example, of the circumstances when a patient should be referred to hospital for treatment.

In the case of Darnley, the NICE guidelines in question (*Head injury: triage, assessment, investigation & early management of head injury in infants, children & adults) recommended that patients with a head injury should be triaged within 15 minutes of arrival at A&E.

Mr Darnley’s case was that he was advised by the receptionist, that he would have to wait in the region of 4-5 hours before being seen. After waiting for 19 minutes, Mr Darnley decided not to wait and left the A&E department. He later became unwell and had to be brought back to A&E. A CT scan revealed an extra-dural haematoma and he was left with a left sided hemiplegia. He argued that if he had been properly advised of the correct waiting time, he would not have left the hospital, he would have been seen and the outcome would have been avoided.

There were 2 issues for the court to consider:

  1. The weight to be placed upon compliance with the NICE guidelines; and
  2. The extent to which a patient must take responsibility for themselves.

The guidelines

The parties’ experts agreed that although the guidelines recommended that a head injury patient should be triaged in 15 minutes, this target cannot always be practically achieved in the busy setting of A&E. They considered that a patient being triaged and seen within 30 minutes, would be acceptable practice. Mr Darnley’s case that it was negligent for him not to be seen in 15 minutes, was unsuccessful.


Patient responsibility

The Judge accepted the claimant’s evidence that had he been advised that he would be seen in 30 minutes rather than 4-5 hours, he would have waited. However the Judge said:

“We seem to live in an age where there is in perception at least, increasing reluctance by individuals to take personal responsibility for their own actions. Here, the claimant’s case on this issue broadly stated that it was the fault of the receptionist that he left the hospital and thus their fault for everything that flowed from such departure”.

For a medical defence lawyer it is refreshing to hear of such a common sense approach, as we so often come across cases where patients, for example, fail to take prescribed medication or fail to turn up to appointments and later seek to blame the doctor when they become unwell.

In Mr Darnley’s case, he was aware he had suffered a head injury and he knew that at some point he would be seen but nevertheless took the decision to leave A&E and sadly ended up with a serious condition.

NICE guidelines and other guidelines and protocols are very important in order to maintain a high standard of care and treatment, and few clinicians would argue otherwise. However they are guidelines and should be taken into account, however lawyers should be cautious about litigating a case predicated solely on the failure to follow the guidelines to the letter, particularly when there is evidence that the overall treatment given was reasonable.

*The guidelines referred to above have now been replaced by Head Injury: assessment and early management.

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