Stewart v Metro North Hospital and Health Service [2025] HCA 34
In Stewart v Metro North Hospital and Health Service the High Court clarified how damages for future care should be assessed when an injured person wants to live at home rather than remain in institutional care.
The Court found that the assessment should not be reduced to a comparison between the health benefits of home care and its higher cost. The central question is whether living at home is a reasonable way of addressing the consequences of the injury.
What happened to Mr Stewart?
Mr Stewart suffered catastrophic injuries following negligent treatment at Redcliffe Hospital in 2016. Metro North Hospital and Health Service admitted liability.
Mr Stewart suffered bowel perforations, sepsis, cardiac arrest, and a stroke. He was left with brain damage, significant physical impairments, and extensive ongoing care needs.
Before his injuries, Mr Stewart lived in a home with his brother, where his son and the family dogs regularly stayed. Following his discharge from hospital, he moved into an aged care facility.
Mr Stewart was unhappy there. His son could not easily stay with him, he could not keep a dog, and his physical condition deteriorated partly because of limited engagement with therapy and exercise.
He sought damages calculated on the basis that he would move into a rented home with appropriate nursing, medical, and personal care.
Why was home care refused by the lower courts?
The evidence showed that living at home would improve Mr Stewart’s quality of life and provide physical and psychological benefits.
However, home-based care was estimated to cost approximately $4.91 million over his remaining life expectancy. Continued institutional care with additional therapy and a dedicated external care assistant was estimated to cost approximately $1.08 million.
The Supreme Court concluded that home care was not reasonable because its health benefits were not sufficiently greater to justify the additional cost. Mr Stewart was awarded approximately $2.19 million in total damages.
The Queensland Court of Appeal upheld that approach, subject to a minor adjustment to the award.
What did the High Court decide?
The High Court unanimously allowed Mr Stewart’s appeal.
It found that the lower courts had asked the wrong question. The reasonableness of home care could not be determined simply by weighing its additional health benefits against its cost.
The assessment had to begin with the compensatory principle: so far as money can achieve it, damages should place an injured person in the position they would have occupied if the negligence had not occurred.
Mr Stewart had lived in a home environment before his injuries. Returning to a home where his son and a dog could stay was a reasonable way of restoring important parts of the life he had lost.
Once Mr Stewart established that his choice was reasonable, it was for Metro North to prove that the expense could have been avoided through a reasonable alternative that he had unreasonably refused. Metro North did not do so.
The High Court set aside the earlier orders and returned the matter to the Supreme Court of Queensland for damages to be reassessed.
What does the decision mean for future care claims?
Stewart does not establish that an injured person will always be entitled to the cost of home care. The proposed arrangement must still be reasonable, and its cost remains relevant.
However, a cheaper institutional arrangement is not automatically the appropriate measure of damages.
When assessing future care, the court may consider more than basic medical needs. Relevant matters can include:
- The person’s living arrangements before the injury;
- Their relationships with family members;
- Their ability to participate in therapy and community activities;
- Psychological wellbeing and quality of life;
- Their clearly expressed wishes; and
- Whether the proposed arrangement is practically achievable.
The decision is particularly significant for catastrophic injury and medical negligence claims. It confirms that future care is assessed by considering how the consequences of an injury can reasonably be repaired, rather than simply identifying the least expensive arrangement available.
This case note is a general summary of the decision and does not constitute legal advice.