Conflicting duties for health professionals and hospitals - statutory duties can override duty of care to third parties

In brief - High Court rules in case involving conflicting duties

A recent decision of the High Court resolves the question of inconsistent duties of doctors and hospitals in the context of involuntary patients and third parties.

Tragic outcome after mentally ill patient discharged from hospital

Two cases tried and determined together, Hunter and New England Local Health District v McKenna; Hunter and New England Health District v Simon & Anor [2014] HCA 44, concerned a nervous shock claim brought by the family of a man who was tragically killed by his mentally ill friend after the friend was discharged from hospital. 

The High Court ruled that the hospital did not owe a duty of care to the family because any such duty would have conflicted with a statutory duty. 

Family of deceased argue that hospital was negligent

The nervous shock claim resulted from the actions of a mentally ill man who was admitted to a hospital in NSW after suffering an acute episode and who was subsequently held as an involuntary patient pursuant to the Mental Health Act 1990 (NSW) (now repealed) ("the Act"). The mentally ill man was discharged from the hospital, into the care of a friend, who agreed to drive the man back to Victoria so that he could continue his treatment. 
 

Tragically, during the drive, the man had another episode and killed his friend. He then subsequently took his own life. Family of the friend commenced proceedings against the hospital in the District Court of NSW for damages for psychiatric injury. 
 

The family of the friend argued that the hospital negligently put their relative at risk. The hospital was successful at first instance, but the decision was overturned on appeal. The hospital then obtained special leave to appeal to the High Court. 
 

Statutory duty inconsistent with pleaded common law duty
 

The central issue for the court to resolve was a conflict between a statutory duty on the one hand and a pleaded common law duty on the other. The family argued that the hospital was under a common law duty of care to regard the interests of those who a mentally ill person might come into contact with if released from its care (in this case, them). 
 

However, this duty conflicted squarely with the hospital's statutory obligation (pursuant to the Act) to discharge a patient if voluntary rather than involuntary treatment was available and appropriate. The court allowed the hospital's appeal, holding that the pleaded common law duty did not exist because the relevant provisions of the Act were completely inconsistent with such a duty. 
 

No duty of care owed by hospital to third parties

The court had to consider whether or not the hospital owed a duty to take reasonable care to protect other persons from harm when deciding to discharge a patient who had been involuntarily admitted pursuant to the Act. The wording of the Act was crucial. 
 

Under section 20, involuntary patients cannot be detained continuously in a hospital unless the hospital forms the view that "no other care of a less restrictive kind is appropriate and reasonably available to the person". In this case, the doctors and the relatives of the mentally ill man agreed that there was "less restrictive" treatment available to him, at home in Victoria. On that basis, the hospital was obliged under the Act to discharge its patient. 
 

The court looked to its previous decisions for guidance on inconsistent duties and said that where it is argued that a hospital may owe inconsistent obligations to a patient and a third party, then that would ordinarily be a reason for denying that a duty exists. 
 

The court held that a hospital could not comply with its obligations under the Act, and at the same time owe a common law duty of care to have regard to all persons who may come into contact with someone discharged from its care. Given that the competing duties were inconsistent, the court held that no finding could be made that a duty of care was owed by the hospital to the relatives. 
 

Decision provides welcome guidance to doctors and hospitals

Hunter & New England is an important decision which resolves the question of inconsistent duties of hospitals and doctors in the context of involuntary patients and third parties. It confirms the general principle that statutory duties can override an inconsistent common law duty of care in some circumstances. 
 

The decision provides some welcome guidance to hospitals and doctors making tough decisions in respect of mentally ill patients. The decision also makes it clear that the requirements under the Act (and equivalent legislation in other jurisdictions, particularly those dealing with a person's liberty), will take preference over the potential risk to third parties. This decision will be influential in all Australian jurisdictions.