• In the case of Liverpool Women’s Hospital v Ronayne [2015] E.W.C.A. Civ 588, it was held that a husband could not claim damages for psychiatric injury following a hospital’s negligence in performing his wife’s hysterectomy because it was not sufficiently sudden. Furthermore, his wife’s appearance was not exceptional for someone in hospital in such circumstances or ‘horrifying’ in the sense used in the authorities.

Facts of the Case

  • C’s wife was admitted to the Liverpool Women’s Hospital, administered by D, where she underwent a hysterectomy.
  • A few days after discharge C’s wife became unwell. Ten days after the hysterectomy, she was admitted to the Royal Liverpool University Hospital through A&E.
  • Over 24 hours C observed a rapid deterioration in his wife’s condition.
  • Before she underwent emergency exploratory surgery, he observed her connected to various machines, including drips, monitors etcetera.
  • The following day he observed her in her post-operative condition; unconscious, very swollen, connected to a ventilator and was being administered four types of antibiotics.
  • The condition of C’s wife resulted from D’s admitted negligence in the performance of the hysterectomy. Although C’s wife remained in intensive care for a further nine weeks, she ultimately made a complete recovery.
  • Claimant alleged at trial that he suffered PTSD resulting from the shock of seeing his wife’s sudden deterioration and in particular her appearance on the two described occasions. Therefore, C tried to claim damages as a secondary victim of D’s negligence.


  • Did the sudden appreciation of the described events cause C’s psychiatric illness?
  • Were the events concerned were of a ‘horrifying nature’?

Held by the Court of Appeal (Civil Division)

  • Finding for D, that it was wrong to treat as one event the period of 36 hours beginning with C seeing his wife before surgery, through to the moment when he saw her in her postoperative state.
  • C’s perception of what he saw on the two occasions was informed by information received in advance. As such, the necessary element of suddenness did not exist for a secondary victim claim.
  • Furthermore, the sight could not be considered horrifying given the clinical setting, and C had been prepared before witnessing it.

Lord Justice Tomlinson

  • In a hospital, one must expect to see patients connected to machines and drips, and ‘expect to see things that one may not like to see.’ Visitors are to some degree conditioned as to what to expect, and due warning is typically given by medical staff before a considerably distressing encounter.
  • The exceptional case is Walters v North Glamorgan NHS Trust [2002] EWCA Civ 1792. This was unusual because a mother witnessed her infant child undergoing a fit resulting from negligence, and she was unprepared for distress because she had been reassured by further incorrect medical advice.
  • “It follows that this was not a case in which there was a sudden appreciation of an event. There was a series of events which gave rise to an accumulation during that period of gradual assaults on C’s mind. Ward LJ in Walters contrasted what there occurred with a ‘gradual dawning of realisation that her child’s life had been put in danger by the defendant’s negligence,’ which would not have amounted to a sudden and unexpected assault on her mind. That is an apt description of what here occurred…Having been told of the severity of his wife’s condition and that she was being administered a cocktail of antibiotics, it cannot in my judgment be said that what thereafter occurred had the necessary element of suddenness” [40].
  • Furthermore, what C saw was not horrifying by objective standards. On both occasions, the appearance of C’s wife was as would be expected of someone in hospital in those circumstances. 
  • While the appearance of C’s wife was undoubtedly distressing, it did not lead to a sudden violent agitation of the mind, because C was prepared to witness a person in desperate condition and was already extremely angry.