Authored By: Yasmin Nabili
Middlesex University Dubai
Case Summary: Paul and another v Royal Wolverhampton NHS Trust
Court: UK Supreme Court.
Judgement Date: 11 January 2024.
Citation: [2024] UKSC 1.
Introduction:
In the case of Paul & Anor v. Royal Wolverhampton NHS Trust, Andrew Paul’s daughters filed a lawsuit against the Royal Wolverhampton NHS Trust. The plaintiffs claimed that they witnessed their father’s sudden and fatal heart attack because the defendant failed to diagnose and treat his coronary artery disease during his hospitalization 14 months earlier. As secondary victims—people who were not physically hurt but were emotionally scarred by seeing a careless incident involving a close relative—they were impaired mentally as a result and filed a claim. The claims in this civil case were related to tort law, specifically clinical negligence. It specifically highlighted an important legal question: What is the extent to which a medical practitioner is liable for mental harm resulting from medical negligence, and do they have a duty of care to an individual who is not directly affected by their negligence? The High Court initially dismissed the case on the grounds that secondary victim claims resulting from medical malpractice, in the absence of a qualifying accident, were not supported by case law at the time. The Court of Appeal upheld this ruling. After the High Court first dismissed the case and the Court of Appeal upheld it, the Supreme Court heard an appeal. This overview is focused exclusively on the Paul case, although it was heard alongside Polmear v. Royal Cornwall Hospitals NHS Trust and Purchase v. Ahmed, which presented materially comparable issues.
Facts of the Case:
In November 2012, Andrew Paul complained of chest pain and went to New Cross Hospital, which the Royal Wolverhampton NHS Trust runs. The hospital was accused of negligently failing to identify and treat his underlying cardiac problem. While shopping with his daughters in January 2014, fourteen months later, Mr. Paul had a sudden and deadly heart attack. His collapse was seen by the children, who were also present when unsuccessful attempts were made to revive him. Due to the devastating incident, both of his daughters suffered from severe mental illnesses. The claimants contended that the defendant’s negligent
inability to identify a potentially fatal illness was the direct cause of their injuries. They filed their claim as secondary victims as they were not patients themselves, in accordance with the guidelines set down in Alcock v. Chief Constable of South Yorkshire Police and further developed in Taylor v. A Novo (UK) Ltd. They claimed to have suffered psychological harm as a result of seeing the results of medical malpractice.
Legal Issue:
The main issue in the case was related to whether a hospital owed the claimants, who experienced psychological harm after seeing a close relative die due to medical malpractice months prior, a duty of care. In particular, the Supreme Court had to determine whether or not such a series of incidents qualified as a legally recognized “accident” that would result in secondary victim culpability. In assessing liability for psychiatric harm, the case also raised questions about the extent of regulations, proximity, and predictability. An additional concern was whether the “control mechanisms” outlined in Alcock—such as proximity in time and place, the closeness of the relationship, and perception of an unsettling event—applied differently in situations involving medical negligence as opposed to accidents. Despite the fact that their father’s untimely death occurred a considerable amount of time after the negligent act, the plaintiffs contended that the horrific incident they witnessed should be deemed qualifying.
Arguments:
The appellants contended that they have a legitimate claim as secondary victims, as they satisfied all of the Alcock requirements. They believe they met the first requirement as they witnessed the event firsthand. They further contended that it was reasonably foreseeable that a failure to recognize a life-threatening disease may ultimately result in such trauma, given their strong familial relationship and the event’s evident psychological impact. Finally, the claimant emphasized that an accident and a clinical event should be classified as the same because both result in equally devastating outcomes and are directly linked to an irresponsible act by a doctor.
The respondent argued that a duty of care to family members who experience psychological distress due to circumstances that transpire following the claimed error should not be recognized by the law. The NHS stressed that there must be a qualifying “accident” in the legal sense—an abrupt, external, and startling incident brought on by carelessness. They referenced Taylor v. A Novo, in which the Court of Appeal determined that a postponed injury or death did not satisfy the required standards. The defendants cautioned that if liability were expanded to include the long-term effects of clinical omissions, there would be significant policy ramifications.
Court’s Analysis:
After careful consideration, the UK Supreme Court, by a majority ruling written by Lord Leggatt, followed the prior courts and dismissed the appeal. They reiterated that under English Law, the duty of care for secondary victims’ psychological harm was strictly limited and did not apply in circumstances that resembled the one at hand. The ruling made an apparent distinction between the natural outcomes of a medical condition, even if it was carelessly left untreated, and an “accident” brought on by negligent conduct. The court reasoned that Mr. Paul’s fatal heart attack did not qualify as a “external traumatic event” as needed by precedent since it was the result of a pre-existing illness rather than a distinct accident. The court emphasized that although psychiatric harm must be predictable, this requirement is insufficient on its own.
Additionally, a qualifying event must be perceived directly and in close proximity to the individual. The daughters’ experience of Mr. Paul’s death was both causally and temporally separated from the earlier inability to diagnose his heart condition. The decision in Taylor v. A Novo was upheld, affirming that legal culpability cannot be applied to such a large time frame as it may affect the fairness and clarity of negligence law.
The court further emphasized how crucial it is to keep clinical negligence claims consistent with the overall tort law framework. It specifically denied the idea that, due to the intensely emotional and intimate nature of the harm, a more accommodating or compassionate approach ought to be adopted in medical settings. Lord Leggatt issued a warning against judicial innovation that could conflate long-standing legal principles or create ambiguous duties for medical practitioners. He reaffirmed that expanding liability to include mental harm brought on by postponed consequences of carelessness without a qualifying traumatic incident would compromise legal certainty and run the risk of an uncontrollably significant deviation from the duty of care. This reinforcement of stringent regulations also reflects the court’s concern with controlling the extent of blame in order to protect defendants’ fairness and avoid an overabundance of claims that would strain the healthcare system.
Decision:
Thus, the appeal was unanimously denied by the Supreme Court. The court found that the claim fell outside the recognized parameters of secondary victim culpability, as there was no legally recognized “accident” that connected the initial negligence to the subsequent traumatic occurrence. Nevertheless, Lord Burrows dissented from the decision on principle, as he viewed a more accommodating approach, focusing on the predictability and fairness of enforcing a duty in such emotionally charged and medically related circumstances, may be helpful and necessary.
Significance:
The decision has significantly changed the law pertaining to secondary victim claims and psychological injury, especially when it comes to medical negligence. It considerably narrows the range of situations in which plaintiffs may be compensated for witnessing the distressing effects of careless medical treatment. The Supreme Court has essentially restricted secondary victim claims to a limited number of instances by restating the need for a single, external, and instantaneous “accident,” hence rejecting the majority of clinical negligence scenarios in which the trauma takes place long after the duty was breached. This ruling supports the notion that public policy variables, such as restricting the extent of liability and avoiding an influx of claims, continue to be crucial in psychological harm cases, solidifying the stringent approach initiated by Taylor v. A Novo. The Paul v Royal Wolverhampton NHS Trust case stands as the primary authority for this line of reasoning because of its thorough factual analysis and significant public interest.
Additionally, the ruling upholds the premise that, in cases of negligence, judicial recourse depends more on precisely defined legal obligations than on moral empathy or feelings of compassion. As a result, the ruling effectively gave the responsibility of future reform to Parliament, permitting legislative intervention. Therefore, in the future, if the current legal constraints do not accurately reflect the contemporary conceptions of trauma and proximity in medical settings, they can be altered.
Conclusion:
In conclusion, the case demonstrated the court’s hesitations to explain secondary victim liability in cases involving medical malpractice. Even if the claimants’ emotional pain was genuine and predictable, the law has stringent conditions that were not fulfilled in this instance. Although the ruling clarifies a previously ambiguous area, it also faces criticism for its alleged rigidity and inability to adjust to the realities of psychiatric trauma. If change is to occur, the verdict calls for legislative reform rather than judicial reform, and it reaffirms established legal limits. As of June 2025, there have been no notable developments, while scholarly and legal commentary on the ruling continues to be ongoing.
Reference(S):
- Paul and another v Royal Wolverhampton NHS Trust [2024] UKSC 1 2. Polmear v Royal Cornwall Hospitals NHS Trust [2024] UKSC 1
- Purchase v Ahmed [2024] UKSC 1
- Alcock v Chief Constable of South Yorkshire Police [1992] 1 AC 310 (HL) 5. Taylor v A Novo (UK) Ltd [2013] EWCA Civ 194
