Hartfield v Calvary Healthcare ACT Ltd (No 3) [2024] ACTSC 137
Key takeaways
- Evidence that is provided ‘late in the day’ in court proceedings must contain substantial new information, rather than reiterate previously addressed points.
- Pleadings need to directly respond to the specific claims made.
- The “Policy Defence”, which limits public authorities’ exposure in claims of negligence, does not require a specific pleading for its general principles to apply.
Background
In 2019, Emily Hartfield experienced an ectopic pregnancy and sought treatment at Calvary Public Hospital. She was admitted and discharged twice before undergoing emergency surgery for a ruptured left ectopic pregnancy.
Hartfield filed a claim in 2022, alleging that the Hospital failed to undertake further investigations (including a laparoscopy). She alleged that a laparoscopy would have resulted in the immediate diagnosis of an ectopic pregnancy, preventing such an invasive surgical option.
The hearing of the matter occurred from 11 September 2023 to 15 September 2023, following which the parties filed written submissions.
As a consequence of those submissions, the Plaintiff filed an application to amend the Statement of Claim. The Plaintiff alleged an alternative case, being that even if:
- it was not appropriate for a laparoscopy to be undertaken; and/or
- the ectopic pregnancy was not apparent on the laparoscopy
the Defendant breached its duty to the Plaintiff by discharging her, rather than continuing to monitor her pain.
The Plaintiff asserted that even though in such circumstances her fallopian tube still would have ruptured, the ectopic pregnancy would have occurred in the hospital rather than at home. This would have lessened the Plaintiff’s psychological distress.
In response to the Amended Statement of Claim, the Defendant served a Further Supplementary Report of a Gynaecologist and Obstetrician Expert on 8 April 2024. The Defendant filed a Further Amended Defence on 9 April 2024.
On 25 April 2024, the Plaintiff objected to specific paragraphs in the Further Amended Defence, which they argued pertained to a new pleading. The paragraphs related to resourcing and responsibilities of public authorities, pursuant to s 110 of the Civil Law (Wrongs) Act 2002 (ACT) (‘CLWA’).
Those objections were not resolved, and the Plaintiff filed an application seeking the paragraphs be struck out and the Further Supplementary Report be ruled as inadmissible.
The Application
The Application proceeded before Justice Baker.
Admissibility of Further Supplementary Report
The Defendant’s Further Supplementary Report addressed the following issues:
- The feasibility of retaining patients with unresolved medical conditions
- The commonality of stress and anxiety in patients with obstetric issues, and
- The necessity of further diagnostic procedures, such as a laparoscopy, during initial admission.
The Further Supplementary Report, in short, provided the following opinions:
- It is not always feasible for prolonged inpatient stays for diagnostic purposes
- It would not have been standard practice to keep the Plaintiff in the hospital given the symptoms she exhibited
- Stress and anxiety are common in patients admitted to the Emergency Department with obstetric issues, and
- The ultimate outcome of the Plaintiff’s condition would not have changed if she had been in the Hospital when the rupture occurred.
Justice Baker, in her judgment, highlighted that the Report covered issues previously addressed at an expert conclave during the initial hearing dates. The report considered the appropriateness of Hartfield’s discharge and the impact on her medical outcome. Justice Baker emphasised that this was central to the Plaintiff’s primary claim, rather than the alternative case arising from the Amended Statement of Claim.
The Report was ruled inadmissible as the Court found that the responses to questions concerning the Plaintiff’s primary claim did not add new substantial evidence, but rather reiterated points already covered. The probative value of the report was substantially outweighed by the danger that the evidence may cause an undue waste of time pursuant to s 135(c) of the Evidence Act 2011 (ACT).
The Pleading of the “Policy Defence”
Subsequent to the Plaintiff’s Amended Statement of Claim, the following paragraphs were pleaded in the Further Amended Defence:
40․ The Defendant relies upon section 110 of the Civil Law (Wrongs) Act 2002 with respect to the alleged duty and alleged breach:
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- A hospital cannot, as a practical matter, retain every patient as an inpatient until their medical condition has favourably or fully resolved without any risk of harm; and
- A hospital is entitled to discharge a patient with a medical condition which has not favourably or fully resolved, following clinical review, with advice to seek medical review or return in the event of any concern or deterioration.
41․ The functions required to be exercised by the hospital are to be decided by reference to the broad range of its activities (and not only by reference to the matter to which the proceedings relates).
Particulars
In accordance with the expert opinion:
-
-
- it is commonplace for clinically stable patients to be discharged from hospital with some pain or discomfort, as part of their recovery;
- it is commonplace for clinically stable patients to be discharged from hospital with instructions about when to return;
- it is commonplace for clinically stable obstetric/gynaecological patients to be discharged from hospital for further tests and follow up in an outpatient setting such as the Outreach Programme;
- clinically stable obstetric/gynaecological patients who are having a miscarriage or have a PUL are commonly discharged with advice, until further developments occur which enable a definitive diagnosis to be made;
- keeping all patients with discomfort, pain and/or no definitive diagnosis in hospital until their diagnosis is definitive or they have no pain or discomfort at all is not clinically supported, including for this patient, and would overburden the hospital system.
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Chapter 8 of the CLWA was introduced as a consequence of certain recommendations arising from the Ipp Review. The chapter creates the “Policy Defence” by collectively resulting in limited exposure regulating public authorities in claims of negligence.[1]
Section 110, which is contained in Chapter 8 of the CLWA, reads as follows:
Principles about resources, responsibilities etc of public or other authorities
The following principles apply in deciding in a proceeding whether a public or other authority has a duty of care or has breached a duty of care:
(a) the functions required to be exercised by the authority are limited by the financial and other resources reasonably available to the authority for exercising the functions;
(b) the general allocation of the resources by the authority is not open to challenge;
(c) the functions required to be exercised by the authority are to be decided by reference to the broad range of its activities (and not only by reference to the matter to which the proceeding relates);(d) the authority may rely on evidence of its compliance with the general procedures and applicable standards for the exercise of its functions as evidence of the proper exercise of its functions in the matter to which the proceeding relates.
In consideration of the Further Amended Defence, Justice Baker commented the following:
- Defendant’s Pleadings Lack Responsiveness: The Further Amended Defence did not directly address the specific claims raised in the Amended Statement of Claim. Instead, they engaged with the Plaintiff’s general arguments about hospital practices and resource allocation, which were not new issues, but rather reiterations of existing arguments.
- Resource Allocation Argument Does Not Require Specific Pleading: The Defendants relied on s110 of the CLWA, being the principle that hospital functions are limited by available resources. The Court noted this argument did not require specific pleading and that the general principles under s110 apply irrespective of whether they are explicitly cited in the Defence.
- Adverse Effect on Plaintiff’s Case: The Court agreed with the Plaintiff that the Further Amended Defence could potentially divert attention from the specific allegations of negligence and onto broader policy issues. This shift could complicate the legal arguments and introduce unnecessary complexity into the case.
The Court ultimately struck out the paragraphs. It emphasised the need for the Defence to directly address the specific claims made by the Plaintiff. The Court also clarified that striking out these paragraphs did not prevent the Defendant from making submissions regarding the application of s 110 of the CLWA during the proceedings.
The Orders
The Court made the following order:
- The Further Supplementary Report is not admissible.
- Paragraphs [40] and [41] of the Further Amended Defence are struck out.
Conclusion
The judgment highlights two critical points:
Admissibility of Evidence Late in the Day: The inadmissibility of the Further Supplementary Report emphasises that ‘late in the day’ evidence must provide substantial new information rather than reiterate previously addressed points. This ensures that court proceedings are efficient and focused on the central issues of the case.
Responsiveness of Pleadings: The striking out of paragraphs [40] and [41] from the Further Amended Defence illustrates the necessity for pleadings to be directly responsive to the specific claims made. Broad, generalised arguments, especially those already well-established, should not overshadow or divert attention from the particular allegations at hand.
The decision also reinforces the governing principles with respect to the “Policy Defence” in the CLWA, and confirmed that the ‘Defence’ does not require specific pleading.
This Case Note was written by Senior Associate Jesse Iliopoulos with the assistance of Paralegal Amy Gasnier. Please contact Jesse if you have any questions or require further information.
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