North Glamorgan N.H.S. Trust v Walters

Factual and Procedural Background

This case concerns whether a mother can recover damages for a pathological grief reaction suffered after witnessing her young child's epileptic seizure in hospital and subsequent death following negligent medical treatment. The hospital admitted negligence leading to the child's death. The trial judge awarded the mother special damages of £1,216 and general damages of £20,000 and granted permission for the NHS Trust to appeal.

The claimant gave birth to her son who, at ten months old, was admitted to a hospital with jaundice and later misdiagnosed with hepatitis A instead of acute hepatitis leading to liver failure. The child’s condition deteriorated, culminating in a prolonged epileptic seizure at 3 a.m. witnessed by the claimant, transfer to another hospital for a liver transplant, discovery of severe brain damage, and eventual withdrawal of life support, with the child dying in the claimant’s arms approximately 36 hours after the seizure.

The claimant experienced a severe psychiatric reaction described as pathological grief reaction, distinct from normal grief, with symptoms including nightmares, suicidal feelings, alcohol misuse, and impaired employability. The trial judge found the claimant was a secondary victim and that her psychiatric illness was caused by shock arising from a sudden appreciation of a horrifying event spanning the 36-hour period from the seizure to the child's death.

Legal Issues Presented

1. Whether the 36-hour period beginning with the child's epileptic fit and ending with his death can be treated as a single horrifying event for the purpose of establishing liability for psychiatric injury.
2. Whether the claimant's appreciation of this event was sudden, as required by the law on nervous shock, rather than a gradual accumulation of distress.
3. Whether the judge erred by expanding the established control mechanisms governing claims for psychiatric injury.
4. Whether the court should take an incremental step in the law to relax the shock requirement and allow recovery for psychiatric illness caused by directly witnessing or experiencing trauma over a period.

Arguments of the Parties

Appellant's Arguments

• The judge erred in law by treating the 36-hour period as one horrifying event rather than a series of events.
• The judge wrongly held that the claimant's appreciation of the event was sudden rather than a gradual mental assault.
• The judge improperly expanded the control mechanisms limiting secondary victims' claims without sufficient regard to policy constraints.

Respondent's Arguments

• If the primary case fails, the court should take a small incremental step to modify the law by replacing the shock requirement with a test that psychiatric illness need only be caused by directly witnessing or experiencing trauma.
• The entire 36-hour period can realistically be viewed as a single horrifying event, consistent with established case law permitting events to span more than a single moment.

Table of Precedents Cited

Court's Reasoning and Analysis

The court began by affirming the claimant’s status as a secondary victim subject to established control mechanisms requiring a sudden appreciation of a horrifying event causing psychiatric injury. It acknowledged that the law in this area is complex and somewhat unsettled but emphasized adherence to the principles set out in key authorities such as Alcock and McLoughlin.

The court accepted that the term "event" is not confined to a moment in time but can encompass a series of occurrences over a short period, citing Tredget as precedent. It found that the 36-hour period from the seizure to the child's death constituted a single horrifying event, given the claimant’s continuous presence and direct perception of the unfolding tragedy.

The court rejected the appellant’s argument that there was no single horrifying event or sudden appreciation thereof. Instead, it held that the claimant’s appreciation was sudden within the temporal context, involving a series of shocks beginning with the seizure, followed by misleading medical reassurances, and culminating in the devastating news and decision to withdraw life support.

The court distinguished this case from others involving gradual mental assaults or mere knowledge of distressing facts, emphasizing the claimant’s physical and temporal proximity and direct sensory perception of the event and its immediate aftermath.

Policy considerations, including concerns about expanding liability and financial implications for the NHS, were acknowledged but rejected as irrelevant to the factual findings and legal application. The court underscored that any change to the law must come from Parliament rather than judicial innovation.

Holding and Implications

The court DISMISSED THE APPEAL, affirming the trial judge's decision that the claimant was entitled to recover damages for the pathological grief reaction caused by the defendant's negligence.

The direct consequence is that the claimant may recover damages for psychiatric injury resulting from witnessing and experiencing the 36-hour horrifying event. The court held that this decision did not constitute an impermissible incremental development of the law, but rather a proper application of existing principles to the particular facts. No new precedent expanding liability beyond established control mechanisms was created. The court emphasized that future changes to the law must be legislative.