High Court to Clarify Future Care Damages in Catastrophic Injury Case

Stewart v Metro North Hospital and Health Service

The High Court has currently reserved Judgement in an appeal that may reshape the assessment of future care damages in catastrophic injury litigation. In Stewart v Metro North Hospital and Health Service, the core issue is whether a plaintiff’s preference for more expensive, in-home supported care, based on values of dignity, comfort, and familial connection, can justify a higher award of damages over institutional care that is medically sufficient and significantly cheaper.

The decision is expected to clarify the test of “reasonable necessity” under the Civil Liability Act 2003 (Qld) and determine the extent to which subjective preferences and non-clinical benefits are relevant when assessing the costs of long-term care for severely disabled plaintiffs.

Case Background and Procedural History

Michael Stewart suffered catastrophic brain injury in 2016 following negligent care at Redcliffe Hospital, operated by Metro North Hospital and Health Service (MNHHS). He was 62 at the time and became profoundly disabled, with a 96% whole person impairment. Now 71, he is mostly non-verbal, requires 24-hour care, and resides in a high-level institutional aged care facility. MNHHS admitted liability.  

At trial, Mr Stewart’s litigation guardian (his former partner) sought a significant damages award to facilitate Mr Stewart’s return to home-based care with the assistance of support workers. The proposed care plan was $3.83 million more expensive than institutional care. The Plaintiff argued that home care would better support Mr Stewart’s dignity, increase his opportunities for personal connection and autonomy, provide motivation for his participation in ongoing recovery treatment programs as well as align with his previously expressed preferences to be cared for privately. 

Key Findings of the Trial and Appeal Courts

The Supreme Court trial judge, Cooper J, accepted that Mr Stewart had shown a clear preference to live at home and that this preference was expressed sincerely, albeit non-verbally. However, the Court held that this was insufficient to displace the practical and clinical evidence supporting institutional care. That is, the Court remained unsatisfied that the evidence overall supported a finding that Mr Stewart would only engage in additional therapy and exercise regimes if he were to move into his own home, such that the expenses involved in having him cared for at home were warranted. 

Ultimately, the Court found that:

• The level of clinical care Mr Stewart would receive in institutional care was equivalent to that proposed in the home setting;
• There was no reliable evidence that Mr Stewart would only engage in more therapy, physical activity, or social participation if cared for at home; and
• The substantial cost differential could not be justified in the absence of measurable therapeutic or quality-of-life improvements.

The Queensland Court of Appeal unanimously upheld this decision in November 2024. It found that while Mr Stewart’s preferences were relevant and worthy of respect, they could not override the requirement that the proposed care model be both reasonable and necessary. The Court reiterated that “reasonable necessity” requires more than subjective preference, it demands evidence of practical clinical advantage, and proportionality.

The Court concluded that the Mr Stewart had failed to establish that the home care model would deliver any superior outcomes to institutional care. It emphasised that emotional appeal cannot substitute for objective analysis when determining liability for future care costs.

High Court Appeal

The granting of special leave to appeal to the High Court raises a significant legal and ethical question: Can a more expensive care model be deemed “reasonable” where it aligns with a plaintiff’s values and expressed preferences, even if there is a lack of obvious or demonstrable clinical benefit?

Mr Stewart maintains that Queensland’s trial and appellate courts adopted an overly rigid interpretation of reasonableness, failing to sufficiently consider the intangible but meaningful benefits of dignity, independence, and social connection within a home environment. The Respondent, MNHHS, maintains that institutional care meets all clinical requirements and that the law should not require damages to fund a care model that is more costly and, arguably in Mr Stewart’s case, no more effective.

The High Court’s decision will provide long-awaited clarity on how Australian courts should weigh non-clinical factors when determining the scope of future care damages in catastrophic injury matters.

Anticipated Impact

For plaintiffs and legal practitioners: The decision will provide important guidance on the standard of evidence required to justify care models based on subjective preference or lifestyle considerations. It may influence how future care plans are constructed, costed, and argued in litigation involving individuals with impaired capacity.

For insurers and defendants: The outcome will impact the assessment of damages exposure and the evaluation of settlement offers in complex personal injury claims. A decision supporting preference-based care may increase the financial burden on defendants, particularly in high-value catastrophic matters.

For the Courts: The appeal highlights the challenge of balancing fairness, feasibility, and human dignity in cases where plaintiffs are unable to advocate for themselves. It also underscores the role of expert and family evidence in shaping judicial conclusions about what constitutes “reasonable” care.