The latest instalment in what constitutes an ‘accident’ in secondary victim claims?
Boate v Twin Ventures International Ltd [2026] EWCC66
The facts
The Claimant’s infant daughter had been born with complex congenital conditions and was placed on a palliative care plan which included morphine solution administered through a naso-gastric tube by the Claimant at home.
A new prescription issued by the GP surgery contained ambiguous dosage information.
The pharmacy dispensed a preparation at a concentration approximately 20 times higher than intended, without stating the volume to be administered.
The Claimant administered the morphine and her daughter collapsed and stopped breathing normally. She died six days later.
An inquest recorded her cause of death as including accidental morphine overdose.
The Claimant said that she suffered from post-traumatic stress disorder and severe depressive disorder.
Judgment in the County Court
The First Defendant pharmacy and Second Defendant GP surgery applied for strike out or summary judgment of the Claimant mother’s secondary victim psychiatric injury claim.
The applications were refused.
It was held that:
- Administering medication via a naso-gastric tube was capable of constituting an accident within the meaning established in Paul v Royal Wolverhampton NHS Trust [2024] UKSC 1.
- The mother’s integral role in the palliative care plan gave rise to proximity and reasonable foreseeability considerations analogous to those in the unwilling participant cases approved in Alcock v Chief Constable of South Yorkshire [1992] 1 AC 310.
Accident: In Paul, the Supreme Court held that secondary victim liability could only arise from an accident. It defined accident as an unexpected and unintended event causing injury by violent external means, as opposed to a medical crisis. Paul left open whether a scenario in which a doctor injected a patient with a wrong drug or dose, inducing an acute adverse reaction witnessed by a close relative, could constitute an accident. The question was whether administering morphine through a naso-gastric tube constituted an accident within the Paul definition. Violent external means did not import a minimum threshold of force. An external event exposing a person to physical injury was required. An injection met that threshold and there was no basis to distinguish between an injection and administration via a naso-gastric tube. There was a real prospect that a court could conclude that administering medication constituted a sufficient qualifying external event. The fact that the Claimant had performed the act many times before and could not have anticipated harm at the moment of administration was not determinative. If an immediate or almost immediate connection between administering the morphine and the child’s acute reaction could be established at trial, that would bring the case within the Paul definition.
Proximity and reasonable foreseeability: The Claimant satisfied any test of proximity as the child’s mother. She was also the person who was administering the substance. It was reasonably foreseeable that a mother administering a negligently prescribed or dispensed medication that was toxic to her child would suffer injury when she realised what had happened and her child had suffered harm as a result. The claimant had been an integral part of the palliative care plan. The defendants had to have known that she would administer the morphine, and they owed her a duty to ensure that they did not prescribe or dispense a toxic substance. That was qualitatively different from the cases in Paul, where there had been no obvious assumption of risk by the doctor towards the patient’s family. The Claimant’s position was analogous to that of an unwilling participant in the defendants’ negligence.
Comment
Boate is a County Court judgment on an interlocutory application and is therefore not binding authority. However, the case demonstrates how the courts can apply Paul and still distinguish ‘accident’ involving ‘violent external means’ from ‘medical crisis’.
Other recent decisions on applications to strike out secondary victim claims following the decision in Paul, are covered in QMLR articles here and here.
