Case Summary: Stewart v Metro North Hospital and Health Service [2025] HCA 34

Can factors such as the injured party’s dignity, mental health and personal relationships outweigh the issue of cost efficiency when assessing future care compensation?

The case of Stewart v Metro North Hospital and Health Service [2025] HCA 34 has re-enforced the core tort law compensatory principle, restoring the injured party, so far as money can, to the position they would have been in had the tort not been committed.

Background 

Mr Stewart, a 63-year-old father and animal lover lived by the sea in Margate, Queensland with his brother. His son Jesse and his dog Sasha would regularly visit. One day, in 2016, Mr Stewart was feeling unwell with symptoms of nausea and generalised abdominal pain. In an attempt to seek treatment, he attended Redcliffe Hospital, Metro North Hospital and Health Service (MNHHS). Unfortunately, the treatment received was unsatisfactory and caused Mr Stewart to suffer extensive injuries which would ultimately shorten his lifespan to age 76. The MNHHS admitted liability for providing negligent treatment, which ultimately caused Mr Stewart to suffer bowel perforations, sepsis, cardiac arrest, stroke, brain damage, a loss of movement in his right upper limb, right lower limb contractures and the requirement for a colostomy bag.

As a result of MNHHS’ negligence, Mr Stewart’s life in Margate ceased, and he was forced to move to Ozanam Ville Aged Care (Ozanam) within the year. At Ozanam, Mr Stewart was no longer able to own a dog and overnight stays with his son were made difficult and became rare. Mr Stewart’s condition began to deteriorate, his motivation to engage in physical therapy diminished and he became non-verbal. Mr Stewart desired to return to his own residence. He wished to receive nursing care at home and gain the therapeutic benefits of his son and dog staying overnight with him.

Initial Trial

Mr Stewart’s ex-partner, sought damages from MNHHS as Mr Stewart’s litigation guardian, with the aim of fulfilling his wishes to return home.

Despite accepting that Mr Stewart’s return home would provide him with more health benefits than if remaining at Ozanam, a trial judge found that the significant extra costs associated with home care were not justified when compared to the cost of institutionalised care. The trial judge therefore awarded damages for future care based on the costs associated with Mr Stewart continuing to receive care at Ozanam.

Appeal

Mr Stewart appealed the decision on the basis that the trial judge erred in their assessment of reasonableness. Evidence was produced to show it was Mr Stewart’s wish to return to his own residence and that experts considered his physical and mental health outcomes were likely to improve if he received care at home.

On appeal, the trial judge’s decision was affirmed. It was found the benefits of being cared for from home were not evidently greater than he would have received at Ozanam and therefore the significant additional cost was unreasonable.

High Court Appeal

The High Court found that the approach taken by the trial judge and on the first appeal, in terms of assessing reasonableness, was erroneous. Mr Stewart was required to prove that his preference to be cared for at home, rather than in an institution, was reasonable in the context of restoring him to the position he was in prior to the negligence being committed. The High Court found that, given Mr Stewart’s pre-injury status and personal circumstances, the cost of home care was a reasonable means to repair the damage caused by the negligence. Additionally, MNHHS was found to have failed to establish it was unreasonable for Mr Stewart to reject the option of receiving care from Ozanam.

Reasonableness Test 

The High Court outlined that the test for reasonableness comprises of two considerations:

1. Is the injured party’s proposal a reasonable response to restore them to their position pre-injury? If yes; 
2. Has the injured party unreasonably refused to mitigate loss or adopt an alternative? 

In determining the first point, parties must assess whether the claim is a reasonable consequence of the tort, and the injured party must prove the reasonable cost of the claim. In this case, Mr Stewart established that his claim for damages reflecting a care model that allowed him to return to his home, rather than remain in an institution, was not unreasonable. Prior to the negligence, Mr Stewart had lived in his own home with regular and ongoing visits from his son and dog.

Additionally, private in-home care was considered to be beneficial for his physical and mental health. The option of remaining at Ozanam would not have restored the applicant to the position he was prior to the negligence of MNHHS, therefore Mr Stewart’s claim could not be found to be unreasonable.

The second point focussed on the onus of the negligent party. The negligent party must prove that a reasonable alternative was offered to the injured party and it was refused, or the injured party refused to mitigate their loss. In this case, MNHHS was unable to establish that service providers at Ozanam would develop the rapport with Mr Stewart required to motivate him to engage in therapy and assist in his treatment. The respondent failed to establish that the alternative option of Mr Stewart remaining at Ozanam would have the same or similar beneficial impact on his physical and mental health.

Future considerations for insurers 

This case emphasises the importance of insurer’s recognising the injured party’s personal choices in the context of their pre-injury status, as genuine considerations when assessing damages for future care and treatment. It is not a matter of merely weighing up the health benefits and costs of certain care and treatment options, but rather giving consideration to what options will best restore the injured party to their pre-injury position.

If the injured party has made a proposal that is considered ‘reasonable’ in the context of restoring him or her to their pre-injury position the burden passes to the negligent party to prove that there are reasonable, more cost-effective alternatives that would make it unreasonable for the applicant to refuse those alternatives.

The case also highlights the importance of looking at an injured party’s background personal circumstances when considering what is ‘reasonable’ in the context of restoring an injured party to their pre-accident status.