Kralj v McGrath [1986] 1 All ER 54
PSYCHIATRIC INJURY – REMOTENESS OF DAMAGE – QUANTIFICATION OF DAMAGES
Facts
Whilst attempting to deliver twins, the defendant medical professional put his arm inside the plaintiff in an attempt to manipulate one of the unborn children. The child died shortly afterwards as a result of this treatment which was accepted to have been negligent. The mother suffered grief which also gave rise to nervous shock and caused a delay in her physical recovery from the ordeal. She sought damages for psychiatric injury and for the future financial cost of having another child (as she and her husband already had one but had planned to have three in total).
Issues
There were two principal issues at stake: firstly, whether an award of aggravated damages was appropriate to reflect the distress and psychiatric injuries caused to the mother; secondly, whether the cost associated with having another child to replace one which had died was too remote to be recoverable.
Decision/Outcome
The court held that although aggravated damages are not generally appropriate in cases of medical negligence, particular distress which has delayed the patient’s recovery may be taken into account when assessing the quantum of compensatory damages. Similarly, although grief is not a recoverable loss in and of itself, where it gives rise to nervous shock which delays recovery damages may be awarded to reflect this.
The financial cost of a future pregnancy was held not to be too remote a consequence of the medical negligence, and was accordingly recoverable in principle.
Updated 19 March 2026
This article accurately summarises the facts, issues, and outcome of Kralj v McGrath [1986] 1 All ER 54. The case remains good law and continues to be cited in discussions of psychiatric injury, aggravated damages in clinical negligence, and remoteness of damage. The key principles — that aggravated damages are generally inappropriate in medical negligence but that particular distress causing delay in physical recovery may be reflected in compensatory damages, and that grief-induced nervous shock delaying recovery is compensable — remain consistent with the broader development of psychiatric injury law following Page v Smith [1996] AC 155 and White v Chief Constable of South Yorkshire [1999] 2 AC 455, though readers should note those later cases primarily addressed secondary victim claims and did not disturb the principles applicable to primary victims such as the claimant in Kralj. The ruling on recoverability of the cost of a future pregnancy remains an illustrative authority on remoteness in clinical negligence. No statutory changes have affected the core legal principles discussed. The article is suitable for its intended purpose but students should be aware that the broader law of psychiatric injury has developed considerably since 1986 and this case should be read alongside later authorities.
