When a Clinical Risk Expert Witness Explains the Limits of Observation in A&E

Can every patient at risk of seizures be monitored one-to-one?

Following a prior blog exploring a patients fall in an A&E cubicle after suffering a seizure, this follow-up response addresses new allegations from the Claimant, including failures in risk assessment and supervision. The Apex clinical risk expert witness reaffirmed their position: that nursing care was reasonable and aligned with hospital policy at the time.

The issue? The Claimant argued he should not have been left alone in a cubicle, and that his fall would have been prevented had side rails been raised or a risk assessment completed. The expert disagreed, pointing to realistic staffing expectations, policy context, and the unpredictability of epilepsy.

Why policy and risk timing matter in A&E negligence claims

The letter clarified that:

• The patient was not an inpatient at the time of the fall

• Trust policy at the time only required falls assessments after admission, within 4 hours

• A&E departments did not routinely conduct falls risk assessments at that time

• The patient was alert, mobile, and assessed by both nursing and medical staff

• He was not left in a bed, but on a standard A&E trolley, and there was no bed rails policy mandating side rail use in such cases

  
  

“We must not apply hindsight bias to this case. Not every patient with a seizure history can have a staff member assigned to sit with them one-to-one. That is not the standard of care in a working emergency department.”— Apex Clinical Risk Expert Witness

What a clinical risk expert witness evaluates in these scenarios

To determine whether a breach of duty occurred, a clinical risk expert witness will review:

1. The hospital’s falls risk and observation policy

2. The patient’s presentation, behaviour, and mobility on arrival

3. Whether cot sides or supervision were clinically indicated at the time

4. If risk assessments were required based on policy not hindsight

5. Whether clinical actions taken align with national and Trust standards

In this case, no policies mandated falls risk assessment for an ambulant A&E patient who had no ongoing postictal symptoms, no confusion, and was mobile.

Why courts must weigh foreseeability not just risk presence

The key distinction made in the expert response is between known risk and predictability. While the patient had a seizure history, there was no reliable pattern or premonitory signs. He could have experienced a seizure at any point, including while seated in the waiting area or walking.

The expert concluded that unless clinical signs suggest imminent risk, constant observation is not expected, and leaving a seizure-prone patient momentarily unobserved is not negligent if all standard precautions were otherwise followed.