By: Scott Macoun, Natalie Orola, Isaac Buckland and Gigi Lynis
Stewart v Metro North Hospital and Health Service [2025] HCA 34
At a glance
- The High Court of Australia has unanimously overturned a decision of the Queensland Court of Appeal in relation to a catastrophically injured plaintiff’s claim for damages for at-home care.
- The case expands on the test of ‘reasonableness’ for the purposes of assessing damages for future care under section 59 of the Civil Liability Act 2003 (Qld).
Background
In 2016, the plaintiff, a 63-year old, presented to Redcliffe Hospital in Queensland with nausea and generalised abdominal pain. His treatment in Hospital resulted in catastrophic injuries, including bowel perforations, sepsis, cardiac arrest, stroke, and brain damage. He was subsequently discharged in late 2016 to a nursing home where he remained at the time of trial in 2023 and was found to have an estimated life expectancy of five years.
Prior to his injuries, Mr Stewart lived in rented accommodation with his brother and shared custody of his 14-year-old son, who often stayed with him and brought his dog. Mr Stewart was not permitted to keep a dog at the care facility, and it was difficult for his son to stay. His physical condition also deteriorated at the care facility because of lack of therapy and exercise.
Mr Stewart’s litigation guardian sought damages at trial for Mr Stewart to move from a care facility and receive care at his own rented residence, arguing that:
- the care facility failed to meet his medical, social, and nursing needs, and
- compensation awarded was intended to facilitate a move to a private rental residence and at-home care in that residence.
The issue in dispute was whether it was reasonable for Mr Stewart to recover compensation for the future costs of nursing and medical care to allow him to live in his own home as he done prior to the injury, where that expense was going to be substantially higher than the expense of his remaining in a nursing home.
Decisions at first instance and on appeal
At first instance, the Supreme Court of Queensland held that it was not reasonable to require the defendant, Metro North Hospital and Health Service (MNHHS), to pay the significant additional cost involved in moving Mr Stewart from a care facility into his own home.
In reaching that decision, the trial judge undertook a balancing exercise between the benefit of the plaintiff receiving care at his own home against the cost of that transition. Despite accepting that Mr Stewart wished to live in his own home and that Mr Stewart would benefit both functionally and emotionally, the trial judge found the cost was unreasonable in circumstances where Mr Stewart would receive similar benefits from advanced personalised care at a care facility at a lower cost.
The Court of Appeal upheld the trial judge’s decision and reasoning. Their Honours held that the significant difference in cost between:
- Mr Stewart remaining in a care facility with additional therapy and external care assistance, and
- receiving treatment in his own home,
meant that the option of home care was not reasonable. Both options provided substantially the same physical health benefits.
High Court’s decision
Special leave was granted for Mr Stewart to appeal the decision of the lower courts on the ground that the lower courts erred in their consideration of ‘reasonableness’ by weighing up the health benefits of the plaintiff living at home against the very significant additional cost of nursing care at home.
The High Court found that the proper starting point was to return Mr Stewart to the same position he would have been in had MNHHS not acted negligently. In that context, the court had to consider whether it was “reasonable” for Mr Stewart to be returned to living in his own home (and receiving the necessary care in that context).
In considering ‘reasonableness’, the High Court applied a 2-limb test:
- First, the plaintiff must show that the action (in this case, Mr Stewart’s decision to receive care at home) was reasonably required in attempting to restore the plaintiff to the position prior to the tort.
- Second, if that threshold is met, the defendant must prove that the plaintiff acted unreasonably in declining a materially similar, less expensive alternative.
In relation to the first limb, the High Court considered that Mr Stewart receiving care at home was reasonable as it was the closest he would get to restoration to his pre-injury position where his son and dog could freely visit, and his quality of life and mental health would be enhanced as close as possible to pre-injury.
As to the second limb, the High Court found that MNHHS failed to discharge its onus of establishing that Mr Stewart acted unreasonably in refusing the alternative, nursing home option. The difference in expense alone was not sufficient to establish unreasonableness on the part of Mr Stewart. Specifically the High Court held (paragraph 52):
“MNHHS failed to discharge its onus of establishing that Mr Stewart acted unreasonably in refusing the second option despite that option being much cheaper. Although it was possible that Mr Stewart might be equally motivated under the second care option at Ozanam to achieve physical health improvements that were not significantly worse than those that could be achieved at home, MNHHS did not establish any likelihood that the external care assistant would develop the necessary rapport required to motivate Mr Stewart. In other words, unlike the improvement in his physical health that would likely result from Mr Stewart’s care at home, MNHHS did not establish the extent of any likelihood that the second option would improve Mr Stewart’s physical health when compared with his then present arrangements at Ozanam.
“The better quality of life and the mental health improvements that would also result from Mr Stewart living in his own (rented) home, and the ordinary nature of such arrangements for a person in Mr Stewart’s position, reinforce the lack of unreasonableness in Mr Stewart declining the second option despite the substantially lower cost of that option.”
In short, MNHHS did not establish that the alternative cheaper option of additional care within the nursing home would improve Mr Stewart’s physical health to the same extent as was expected from being cared for at home.
The High Court concluded that the trial judge and Court of Appeal erred in simply balancing the costs to MNHHS and the health benefits to Mr Stewart of home care and reinforced that the true nature of the exercise was to attempt to restore Mr Stewart to his pre-injury position.
The appeal was allowed with costs, and the matter was remitted to the Supreme Court of Queensland for assessment of damages.
Implications
The High Court’s decision highlights the fundamental principle that the purpose of compensation is to return the injured plaintiff as near as possible to the position they would have been in had the tort not been committed. When considering a plaintiff’s entitlement to damages, defendants will now have to approach assessments more holistically, placing greater emphasis on the plaintiff’s pre-injury circumstances, balancing not only cost, but also anticipated clinical outcomes, and psychosocial and wellbeing factors.
In assessing damages for care, particularly in relation to catastrophic injuries, defendants may see a rise in claims for damages for home care. In that regard, the High Court distinguished this case from the previous High Court case of Sharman v Evans (1977) 138 CLR 563 (in which a narrow cost-benefit framework was applied) and highlighted that advances in technology mean home care is now more accessible and practical than before.
The potential effect of this is that it may now be easier for plaintiffs to establish the first limb of the “reasonableness” test, subject to their pre-injury circumstances. If established, defendants will then have the onus of proving that the plaintiff’s refusal of a cheaper alternative is unreasonable.