High Court clarifies scope of nervous shock claims in medical negligence cases

In the recent judgment of Kinsella v Carter [2026] IEHC 319, the High Court has made significant clarifications to the law of nervous shock and the ability of relatives to recover for nervous shock where their relative has been injured through medical negligence. In our latest article, Ana Harrington, Solicitor provides an overview of the judgement and its implications for future cases.

Background

The Deceased, who was the wife of the Plaintiff, had been on a daily dose of 10mg Lercanidipine for hypertension. On 18 July 2021 an ambulance was called due to difficulty breathing, and she was admitted to the hospital for management of probable congestive heart failure.

The normal maximum dose of Lercanidipine is 20mg once daily. However, the admitting doctor prescribed 80mg of the drug, which was administered at approximately 08:45 on 20 July and caused a “sudden and catastrophic medical event”. At approximately 09:30 the Deceased became acutely hypotensive.

The hospital telephoned one of the Deceased’s children at 11:40 and advised that the Deceased had “taken a turn”. Several family members, including the Plaintiff, attended the hospital. The Plaintiff gave an account of seeing his wife with “black stuff” coming out of her mouth, this being charcoal that was used to treat the overdose, and of holding her hand while she was unconscious. He was told by a doctor that the doctor did not know what was going on. While leaving the hospital, he stumbled and fell, requiring a short attendance in the ED. One of his daughters gave evidence that he was shaking, shocked, and having difficulty walking. It was not until the next day that he was informed of the overdose.

Over the course of the next 12 days, the Deceased had a “stormy recovery” involving a number of cardiac arrests, before relapsing and ultimately passing away in hospital on 2 August 2021. Evidence was given that it was the family who cleaned the Deceased up and took out the “pipes and tubes” after she passed away, and that once the monitor was turned off they were left alone in the hospital room.

Nervous Shock

Unchallenged psychiatric evidence was that the Plaintiff had developed symptoms of PTSD. Based on the evidence offered, the Court took the view that the disorder had originated in the shocking events of 20 July and then developed and was reinforced over the following 12 days.

The parties agreed that the relevant criteria to determine the issue of nervous shock were those in Kelly and Hennessy. However, there was a dispute over whether the psychiatric illness was ‘shock-induced’ and whether there was a duty of care owed to the spouse of the patient.

‘Shock-induced’

Counsel for the hospital argued that the shock must be a “sudden, traumatic accident”, with Common Law involving specific external events of railway or car accidents, while a medical mishap during treatment does not fit this mould. It also argued that this case was a “continuum” of distressing events, not a single, sudden shock.

The Court held that an ‘accident’ in the context of Kelly v Hennessy is not limited to road traffic accidents or industrial mishaps, and that the overdose in question was an accident that was immediately catastrophic. In particular, it involved a “discrete and unexpected occurrence, distinct from the gradual progression of illness or the cumulative effects of distress” and was “the type of shocking or calamitous episode contemplated in the authorities”.

It was significant that the symptoms for which the Deceased was admitted were unrelated to the overdose, distinguishing it from previous cases such as Morrissey v HSE or Germaine v Day. Because the overdose came from outside the body of the Deceased, it was an external event not akin to an illness, and is therefore differentiated from a misread scan before a patient’s deterioration.

As to whether there was a single ‘shock’, while the Court accepted that the disclosure of the overdose on 21 July and the scene at the death bed on 2 August could not be disentangled, the initial trauma occurred on 20 July, and there was clear temporal proximity between the overdose and the trauma caused to the Plaintiff on that day. While later events added to the effect on the Plaintiff, they did not change this fact. “Shock-induced” need not be limited to a single isolated instant, but can include where an injury “arises from a sudden and horrifying appreciation of an event or its immediate aftermath,” rather than a “gradual accumulation of distress.”

‘Duty of Care’

The hospital admitted breach of duty as regards the overdose but denied that it owed any duty of care to the Plaintiff, and argued that calling relatives to hospital or giving them information does not mean they are assuming such a duty. It further argued that extending the duty of care to patients’ families would shift the focus of care from the patient themselves and influence medical decision-making, and that it would tend to breach the duty of confidentiality, though the Court declined to comment on this point in any detail.

The Court acknowledged that in nervous shock, there is no presumption of a duty to witnesses, and that there is no general duty on the part of hospitals to relatives of patients.

However, the specific circumstances of this case were relevant:

1. This was not a diagnostic omission, but a serious overdose of a daily medication
2. The Plaintiff had arrived at the hospital shortly after the event occurred
3. The Plaintiff perceived the physical manifestations of the overdose while they were ongoing
4. The Plaintiff collapsed in the hospital, requiring assessment in the hospital
5. The manifestations of shock occurred while the hospital was still managing the crisis it had caused.

These circumstances were distinguished from a distressed relative informed after the fact, psychiatric injury arising from grief, or gradual deterioration of a patient where there may have been a misdiagnosis.

Essentially, a hospital will owe a duty of care to a patient’s relative where there is “immediate temporal proximity, direct perception by the plaintiff with a physical manifestation of shock and where the hospital had continuing control of the situation.”

In the Court’s opinion, this did not expose healthcare providers to indeterminate liability.

Conclusion

This judgment establishes useful principles in determining the circumstances which can sustain a claim for nervous shock in the context of medical negligence, as opposed to psychiatric illness which may be attributed to medical negligence but which is not ‘shock-induced’.

While at first glance, this judgment may appear to be an    extension of the law of nervous shock, it is clear that only in exceptional circumstances will a duty of care arise from a hospital to the relatives of its patients. Proximity and foreseeability have long been a factor in applying the criteria of Kelly v Hennessy, and were again central in determining the duty of care in this case.