The Irish High Court (Court) in Kinsella v Carter [2026] IEHC 319 addressed a novel argument raised by a hospital in a claim for damages for nervous shock.

The Court noted the parties acknowledged it to be the first time for a health service provider in this jurisdiction to argue that a nervous shock claim (in this instance by a husband) arising from the admitted medical negligence in the treatment of his wife, who later died, does not constitute an “accident” within the framework described in Kelly v Hennessy.

In Kelly v Hennessy, the Supreme Court identified five requirements for a successful nervous shock claim, including that

• the illness must be “shock-induced”, and
• the plaintiff must show that the defendant owed a duty of care not to cause a reasonably foreseeable injury in the form of nervous shock.

The Court was required to consider whether a sudden catastrophic event, in this case a negligent overdose, occurring in a hospital could constitute an accident capable of giving rise to a “shock-induced” psychiatric injury, or whether an event occurring in the course of medical treatment falls outside that category.

It was also required to consider if, on the facts, a duty of care was owed by the hospital only to the plaintiff’s wife, a patient of the hospital, or if it also owed a duty of care to the plaintiff. The hospital argued that expanding liability to relatives of patients would be novel, open-ended, and indeterminate, and would require a determination by the Supreme Court, as nervous shock claims fall within an exceptional category.

Background

The claim arose from the admitted negligent administration of a substantial overdose of medicine to the plaintiff’s wife, which caused a “sudden and catastrophic medical event“. The plaintiff came to the hospital shortly thereafter and witnessed the immediate aftermath of his late wife’s reaction to the overdose. She later died. The plaintiff subsequently developed Post Traumatic Stress Disorder (PTSD). The hospital accepted negligence in relation to the treatment of the plaintiff’s wife but argued that the plaintiff could not recover damages for nervous shock.

The issues

A central issue was whether the overdose could amount to an “accident” within the meaning of Kelly v Hennessy. The Court held that an accident denotes a “sudden, unintended and externally caused event…capable of producing a direct and shocking sensory impact“. It found that the character of the event, rather than its setting, is determinative. On the facts, the Court found the administration of the overdose was an external event, not akin to an illness or medical crisis. Interestingly, the Court rejected the argument that events occurring in a hospital setting are, of themselves, excluded from the concept of an “accident”.

Regarding the requirement that the psychiatric injury be “shock-induced”, the Court found that this is concerned not with an artificially narrow conception of a single isolated incident. Rather, the question is whether the injury arises from a “sudden and horrifying appreciation of an event or its immediate aftermath”. In this case, the Court was satisfied that the plaintiff experienced an “immediate and overwhelming reaction” on witnessing his wife’s condition.

The hospital also argued that it owed no duty of care to the plaintiff, as he was not a patient. The Court rejected this while making clear it was not recognising a general duty owed by healthcare providers to relatives. Instead, the duty arose on the specific facts, where there was “legal proximity created from contemporaneity and control“. The Court added that it approached this issue “conscious that the law permitting claims for nervous shock is exceptional in character and that duties to victims who are witnesses are not presumed.” The negligence consisted of a serious overdose causing an immediate crisis; the plaintiff arrived within a short time and saw the consequences while still ongoing; and the manifestations of shock occurred while the hospital was actively managing the situation it had created. Therefore, the plaintiff was not merely a distressed relative informed after the event, but a person present during its immediate aftermath.

The defendant sought to rely on the UK Supreme Court decision in Paul v Wolverhampton NHS Trust [2024] UKSC 1, to support its argument that Kelly v Hennessy was limited to a sudden, shocking, horrifying event occurring outside a hospital. The Court distinguished Paul, noting that Irish law has not adopted the primary and secondary victim concepts it applied, and that Paul concerned medical crises following diagnosis rather than a sudden negligent act. The Court further observed that the UK Supreme Court had left open the question of an acute reaction caused by a negligent act, such as administering the wrong drug.

The decision and its impact

The Court found, on the facts, that the plaintiff was entitled to recover general damages of €40,000 from the hospital for the psychiatric injury sustained (together with an agreed sum under the Civil Liability Act 1961).

The decision in Kinsella v Carter does not purport to depart from the principles in Kelly v Hennessy but rather demonstrates their application in a clinical negligence context. It confirms that “accident” is defined by the nature of the event rather than its setting, and that a sudden, externally caused and catastrophic error in medical treatment may give rise to a claim for nervous shock, subject to the established controls of proximity, foreseeability and the presence of a shock-induced event.

Regarding its finding that a duty of care arose on the facts, the Court was careful to add that this conclusion was confined to the specific circumstances of the case and does not establish a general duty owed by healthcare providers to patients’ relatives.

To discuss this judgment and its consequences in more detail, please contact Margaret Muldowney, Mary Cooney or any member of our Healthcare team.

Contributed by Gail Nohilly