A recent Irish decision affirms a willingness to recognise secondary victim psychiatric injury claims arising from acute medical negligence events witnessed or experienced in clinical settings. The United Kingdom Supreme Court's decision in Paul v Royal Wolverhampton NHS Trust continues to be an outlier.
The Irish High Court decision in Kinsella v Carter [2026] IEHC 319 involved a catastrophic medication error occurring in a hospital environment, followed by a claim for recognised psychiatric illness. This decision demonstrates judicial acceptance that sudden medical crises caused by negligent treatment can ground liability for psychiatric injury, and that the UK approach taken in Paul is not one that should be adopted more broadly.
The UK Supreme Court's decision in Paul represented a materially narrower approach to psychiatric injury claims by secondary victims in medical negligence cases.
In Paul, the Court held that claims arising from witnessing the collapse or death of a loved one caused by earlier negligent medical treatment would generally fail because the relevant "accident" was the earlier negligent omission rather than the later collapse itself. The Court treated subsequent collapses as manifestations of disease processes rather than discrete traumatic events caused contemporaneously by negligence.
The decision significantly restricted recovery by secondary victims in UK medical negligence claims and reinforced the distinction between sudden accidents and the gradual consequences of negligent treatment.
The Irish High Court decision in Kinsella v Carter involved a secondary victim psychiatric injury claim brought by the husband of a hospital patient who was negligently administered a substantial overdose of blood pressure medication.
The claimant attended the hospital after being told his wife had "taken a turn". He encountered what the Court described as a harrowing scene, including observing his wife unconscious with activated charcoal emerging from her mouth following the overdose response. The claimant himself physically collapsed and required emergency department treatment.
The claimant's wife later died, and the claimant pursued damages for PTSD as a recognised psychiatric illness arising from shock-induced injury.
Perhaps the most important aspect of Kinsella was the Court's analysis of duty of care in circumstances where, unlike Western Australia, there is no statutory framework to refer to.
The Court rejected the proposition that hospitals owe duties only to patients and not to close relatives exposed to traumatic hospital-created crises. Instead, it focused on legal proximity arising from:
However, the Court emphasised that the duty recognised was tightly confined and fact-sensitive, rather than creating a broad general duty to relatives in all clinical negligence scenarios.
The Irish High Court treated Kelly v Hennessy [1995] IESC 8 as the governing framework for psychiatric injury claims. The hospital argued that medical negligence occurring during treatment was not an "accident" capable of grounding nervous shock liability and relied heavily on the UK Supreme Court's reasoning in Paul.
The Court rejected that submission. It held that the concept of an "accident" within the Kelly framework was not confined to road accidents or industrial mishaps. Rather, the relevant inquiry was whether there had been a discrete, sudden and unintended occurrence capable of producing a direct and shocking sensory impact.
Critically, the Court distinguished gradual disease progression cases from acute hospital-created crises. It characterised the overdose event as an immediately catastrophic occurrence with direct sensory consequences witnessed by a close relative.
The Court expressly addressed Paul and observed that the UK primary and secondary victim taxonomy had not been adopted in Ireland.
The Court further noted that Paul itself left open hypothetical scenarios involving negligent administration of incorrect medication causing an acute reaction witnessed by a close relative, describing the facts before it as precisely that type of case.
The Court also rejected arguments that the claimant's psychiatric injury resulted from a continuum of distress rather than sudden shock. It accepted that while subsequent events reinforced the claimant's distress, the psychiatric injury originated with the traumatic experience beginning on the day of the overdose.
Australia's common law position is very similar to that which was upheld in Ireland. Australian law has moved away from secondary victims having to have witnessed an "accident" or to have suffered a "shock" as a necessary prerequisite to accessing damages for psychiatric injury, although that will be a relevant consideration (at common law and under statute) when the court is considering whether — in the circumstances of the case — it was foreseeable that a person in the position of the plaintiff might suffer psychiatric injury.
For further advice on this topic, please contact Erica Thuijs , Partner Insurance.