What is reasonable when assessing compensation for a plaintiff’s nursing and medical care?

Overview

On 3 September 2025, the High Court handed down its judgment in Stewart v Metro North Hospital and Health Service [2025] HCA 34, examining the issue of reasonableness in relation to a plaintiff’s care preferences where there are multiple reasonable care options available.

Facts

The Plaintiff, Michael Stewart, was admitted to Redcliffe Hospital (Hospital) in March 2016. While there, he was treated negligently, resulting in significant injuries including cardiac arrest and stroke, leaving him with brain damage, consistent pain in the right side of his body, and no movement of his right arm. He was discharged in November 2016 to a nursing home. In March 2017, Mr Stewart was moved to Ozanam Villa Aged Care Facility (Ozanam), where his physical condition further deteriorated due to a lack of therapy and exercise.

Case history

It was accepted at trial that the Hospital was negligent, and therefore liable to compensate Mr Stewart for his injuries. Mr Stewart stated that he wished to use an award of compensation to move into a private residence due to his medical and social needs not being met at Ozanam. The Trial Judge assessed three possible options for compensation:

1. The cost of Mr Stewart remaining at Ozanam, totalling $304,650.46. Due to Mr Stewart’s deterioration at Ozanam, the Trial Judge rejected this option.
2. The cost of Mr Stewart remaining at Ozanam, with additional external care for more frequent therapy, totalling $1,081,895.56.
3. The cost of Mr Stewart being cared for in his own home, totalling $4,910,342.52.

The Trial Judge found that Mr Stewart required additional care. However, His Honour also found that the benefits from the third option above were not significantly better than the second, so as to warrant the extra cost. In accordance with Sharman v Evans (1977) 138 CLR 563, the Trial Judge found it would be unreasonable to require the Defendant to pay the additional costs involved in Mr Stewart being cared for in his own home, which His Honour determined would have only marginal health benefits.

The Court of Appeal affirmed this decision, finding that the additional cost was not reasonable considering the substantially similar benefits of the second and third options. They further found that it had not been established that living at home would result in increased benefits for Mr Stewart than what would be achieved at Ozanam with additional care.

On appeal to the High Court, Sharman v Evans was distinguished on the basis that unlike Mr Stewart, the Plaintiff was assessed to be more physically at risk if cared for at home than in a professional care facility.

Issue before the Court

The primary issue before the High Court was whether the Court of Appeal had made an error in its consideration of reasonableness by failing to take into account:

1. Mr Stewart’s wish to live at home;
2. Such care arrangements being common in the community;
3. His position prior to the Hospital’s negligence; and
4. The psychological and social benefits to living at home.

Mr Stewart asserted that the Court of Appeal had asked the wrong question in relation to reasonableness.

High Court decision

The High Court overruled the Court of Appeal’s analysis of reasonableness, stating that the approach taken in Sharman v Evans, and by the Trial Judge and Court of Appeal here, was incorrect. In assessing Mr Stewart’s claim, the Court emphasised the “compensatory principle”, which requires that a plaintiff is compensated with an amount that would place them, as best as possible, in the position they would have been in had the negligence not occurred.

The Court then discussed the two ways the concept of “reasonableness” limits the application of the compensatory principle:

1. First, the plaintiff must establish that the steps they took were reasonable consequences of the negligence, and that the cost of taking those steps was reasonable. In this case, Mr Stewart was required to prove that the cost of home care was reasonable.
2. Second, once this is proven, the onus is on the defendant to establish that the plaintiff failed to avoid or mitigate that cost by taking a reasonable, alternative option.

The High Court considered that the question in this case was whether Mr Stewart’s choice to live and be cared for at home was a reasonable response to repair the consequences of the Hospital’s negligence.

The High Court found that Mr Stewart acted reasonably in seeking to restore his position to that prior to the negligence by his choice to live in his own home with care. Further, the High Court considered that the Defendant had failed to discharge its onus in establishing that Mr Stewart acted unreasonably in refusing to remain at Ozanam with additional care (second option) as they had not established that he would achieve similar physical health improvements due to the motivation and benefits Mr Stewart would gain by living at home.

The High Court acknowledged that while it was not possible to place Mr Stewart in the same position as he would have been in prior to the negligent treatment, placing him in as close of a position as possible is of primary focus for Courts.

Takeaways

The High Court’s decision in this case clarifies that the test for of reasonableness is employed at two points in the determination of a damages award. The first is whether it is reasonable for a plaintiff to be cared for in the manner that they wish. If Mr Stewart was itinerant and did not own a home, it might be said that it would be unreasonable for him to be compensated to live and be cared for in a home of his own. Once it is determined that the manner of care is appropriate to the circumstances then the question is whether the cost of achieving that is reasonable.