and emergency facility is ten miles away. There is no doctor currently on duty at
the rural hospital which has a sign at the gate advising that there is no accident and
emergency unit within the hospital, and that persons wishing for emergency
treatment should report to their nearest accident and emergency hospital.
One interesting issue here is whether N must offer treatment to the patient. In
Barnettv.Chelsea and Kensington Hospital Management Committee/1968) three
nightwatchmen had vomited continually since drinking tea in the early hours of
the morning of New Year's Day. On finishing their shift they presented themselves
to an accident and emergency department of a London hospital. They reported to a
nurse who telephoned the casualty officer. Without examining the men, he told the
nurse to send them home with instructions to call their own doctors in the
morning. Five hours later, one of the men died from arsenic poisoning. Although
the subsequent claim failed on the lack of proof of causation, it was said that where
aperson with obvious symptoms of illness presents himself to an accident and
emergency department, a duty of care arises so that skill and care should be
employed in the diagnosis of any injury.
This is so even though there will be no prior relationship with the patient.
However, the general view taken by English law is that if a person undertakes to perform a voluntary act he is liable if he performs improperly, but not if he neglects to perform it'. It is for this reason that certain jurisdictions have enactedgood
samaritan' statutes which either place a positive duty on doctors to stop at the
scene of an accident, or offer immunity to medical staff who choose to render
assistance.
Although there is a statutory duty to provide sufficient accident and emergency
services to meet reasonable requirements within a locality, in practice this duty will
prove very difficult to enforce before the courts. There is now a significant body of
case law which demonstrates that the courts will rarely intervene to review a
decision on resource allocation or enforce a claim to be admitted to treatment.
Nonetheless, if a non-accident and emergency hospital chooses to admit a patient
to treatment, then a duty of care will arise. It follows that, in purely legal terms, N
would be free to refuse treatment to V and urge R and V to present themselves to
the nearest accident and emergency department. Nonetheless, once N opts to
render care and assistance to V, then a duty of care arises and the question then
relates to the applicable standard of care. It is clear that liability may result from
negligent treatment or advice rendered by N or any failure of communication in
providing V with emergency treatment.
However, given that the unit is not an accident and emergency unit, then in
accordance with the case ofRoydchv.Krasey/1971) /section 8.3) the circum-
stances in which treatment is rendered will be taken into account in determining
the requisite standard of care. InKnightv.Home Office/1990),it was said that a
prison hospital owes a duty of care to a mentally ill patient which is of a lower
standard than that of a specialist psychiatric hospital. In that case, it was said that:
`In making the decision as to the standard to be demanded the court must bear
in mind as one factor that resources available for public services are limited and
that the allocation of resources is a matter for Parliament... the facilities
available to deal with an emergency in a general practitioner's surgery cannot beResponsibility,LiabilityandScarceResources 143