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Clunis v Camden & Islington Health Authority [1997] EWCA Civ 2918 (5th December, 1997)
URL: http://www.bailii.org/ew/cases/EWCA/Civ/1997/2918.html
Cite as:
[1998] 2 WLR 902,
[1998] QB 978,
[1997] EWCA Civ 2918,
[1998] PNLR 262,
[1998] 3 All ER 180,
(1997-98) 1 CCL Rep 215,
(1998) 40 BMLR 181
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JISCBAILII_CASES_TORT
CHRISTOPHER CLUNIS (by his next friend CHRISTOPHER PRINCE) v. CAMDEN and
ISLINGTON HEALTH AUTHORITY [1997] EWCA Civ 2918 (5th December, 1997)
IN THE SUPREME COURT OF JUDICATURE QBENI 97/0044/E
IN THE COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM THE HIGH COURT OF JUSTICE
(MR RICHARD B MAWREY QC )
Royal Courts of Justice
Strand
London WC2
Friday, 5 December 1997
B e f o r e:
LORD JUSTICE BELDAM
LORD JUSTICE POTTER
MRS JUSTICE BRACEWELL
- - - - - -
CHRISTOPHER CLUNIS
(by his next friend CHRISTOPHER PRINCE )
PLAINTIFF/RESPONDENT
- v -
CAMDEN & ISLINGTON HEALTH AUTHORITY
DEFENDANT/APPELLANT
- - - - - -
(Transcript of the handed down judgment of
Smith Bernal Reporting Limited, 180 Fleet Street,
London EC4A 2HD
Tel: 0171 421 4040
Official Shorthand Writers to the Court)
- - - - - -
MR J GRACE QC with MR A GRUBB (Instructed by Messrs
Beachcroft Stanleys, London EC4A 1BN) appeared on behalf of the Appellant
MR S IRWIN QC with MR J GLASSON (Instructed by Messrs
Thanki Novy Taube, London WC1X 8QG) appeared on behalf of the Respondent
- - - - - -
J U D G M E N T
(As approved by the Court )
- - - - - -
©Crown Copyright
Friday, 5 December 1997
J U D G M E N T
LORD JUSTICE BELDAM: This is the judgment of the court.
In these proceedings the defendant health authority applies to
strike out the claim brought against it by the plaintiff, Christopher Clunis, as
disclosing no cause of action. The defendant’s application was dismissed by
order of Mr R.B. Mawrey Q.C. sitting as a deputy judge of the High Court on 12th
December 1996. The defendant now appeals to this court.
The Facts.
The plaintiff is a patient by reason of mental disorder. He was
born on 18th May 1963 in Jamaica and in 1986 was treated as an in-patient at the
Bellevue Hospital there. He appears to have come to the United Kingdom between
1986-1987, and from 1987 to 1992 he had received psychiatric treatment in
several hospitals in the London area. In August 1992 he was detained as the
result of an order under sec. 3 of the Mental Health Act 1983 at Guys Hospital,
London S.E.1. On 24th September 1992 the responsible medical officer then in
charge of his treatment decided he was fit to be discharged. Although no
criteria are laid down under sec. 23 of the Act for the making of an order for
discharge, it is reasonable to suppose that it was no longer considered
necessary to detain him in the interests either of his own health or safety or
with a view to the protection of other persons. It was, however, the district
health authority’s duty under sec. 117 of the Act to arrange in conjunction with
the local social services authority to provide in co-operation with relevant
voluntary agencies after-care services for the plaintiff until those authorities
were satisfied that he no longer needed them. See sec. 117(2).
The plaintiff had expressed a desire to move to North London and
into the area covered by the defendant health authority. Accordingly a doctor at
Guy’s Hospital contacted the defendant authority and arranged for the plaintiff
to be seen at Friern Hospital on 9th October 1992. As a result of contact
between the doctor at Guy’s Hospital and the defendant authority, Dr. Sergeant,
a psychiatrist employed by the defendant, was designated as the responsible
medical officer as required by the Secretary of State’s code of practice made
under sec. 118 of the Act. The plaintiff failed to attend the appointment at
Friern Hospital on 9th October. An appointment was then made for him to see Dr.
Taylor, the consultant psychiatrist at the hospital on 13th November, but again
he failed to attend. Dr. Sergeant telephoned the plaintiff’s general
practitioner, Dr. Patel, who said that the plaintiff had been removed from his
list of patients because of aggressive and threatening behaviour. As a result,
Dr. Sergeant telephoned Guys Hospital and then contacted Haringey Social
Services asking them to arrange a mental health assessment visit. It was
arranged that this assessment should take place at the plaintiff’s address on
30th November at 3 p.m. On that day the plaintiff apparently left his address
without being recognised by anyone in the assessment team; so the assessment did
not take place.
Following a call from Haringey Social Services on 1st December,
Dr. Sergeant arranged an appointment to see the plaintiff on 10th December. Dr.
Sergeant asked the duty social worker to attend the meeting. It is contended on
the plaintiff’s behalf that, on the information she had, Dr. Sergeant’s
consideration of the plaintiff’s needs “fell below minimum acceptable practice
at that time”. It was over two months since the plaintiff had been discharged
from Guys Hospital and he had still to receive psychiatric care from the
defendant authority. On 10th December the plaintiff again failed to attend his
outpatient appointment and on 17th December Haringey Social Services advised Dr.
Sergeant that local police had called them to say that the plaintiff was “waving
screwdrivers and knives and talking about devils”, but the constable had
apparently not taken any action to remove him to a place of safety under sec.
136 of the Act.
Dr. Sergeant advised Haringey Social Services that the mental
health assessment team should assess the plaintiff as soon as possible but that
she first had to check which social services authority was responsible for the
plaintiff. Later that day at about 3.45 p.m. the plaintiff, who had armed
himself with a knife, in a sudden and unprovoked attack killed Mr Jonathan Zito
at Finsbury Park tube station in London. The plaintiff was charged with Mr
Zito’s murder and on 28th June 1993 at the Central Criminal Court the plaintiff
proffered a plea of guilty to manslaughter on grounds of diminished
responsibility. The plea was accepted. The trial judge, Mr Justice Blofeld,
ordered the plaintiff to be admitted to, and detained in, Rampton Hospital on
the grounds that he was suffering from a mental illness characterised as a
schizoaffective disorder. The court also ordered that he should be subject to
the special restriction set out in sec. 41 of the Act.
The Plaintiff’s Claim.
In his statement of claim the plaintiff contends that he has
suffered injury, loss and damage because the defendant health authority were
negligent and responsible for breach of a duty of care at common law to treat
him with reasonable professional care and skill. In particular it is alleged
that Dr. Sergeant was:
“...responsible for monitoring the implementation of the
plaintiff’s care plan and liaising and co-ordinating where necessary between the
individuals and agencies involved in it”.
She was negligent in that she failed to arrange a mental health
assessment of the plaintiff before 30th November 1992, failed to identify him on
30th November, failed to ensure that an urgent mental health assessment was
carried out before 17th December 1992 and in effect failed in her responsibility
as a key worker to liaise effectively with police, the social services authority
and other agencies to ensure that the plaintiff was assessed before he committed
manslaughter on 17th December. It is said that from information she possessed
Dr. Sergeant ought to have realised that the plaintiff was in urgent need of
treatment and was dangerous. It is further contended on the plaintiff’s behalf
that if he had been assessed before 17th December he would either have been
detained or consented to become a patient and would not have committed
manslaughter. In consequence of the defendant’s breach of duty he will now be
detained for longer than he otherwise would have been and is unlikely to regain
his liberty for many years because of the considerable public interest and
publicity which attended his conviction.
A medical report is exhibited to the statement of claim. It is
from Dr. Shubsachs, one of the consultant psychiatrists whose reports were
relied on to establish diminished responsibility. The report contains the
following paragraph:
“Mr Clunis had a history of seriously violent behaviour before
the homicide of Mr Zito, and any relapses of his illness are likely to be marked
by paranoid interpretations of events and delusions, and there must be a strong
likelihood, if he did relapse, that violent behaviour would result. Thus, even
if he had not attacked Mr Zito, the management of his illness in the community
would have required close monitoring.
Therefore, the “prognosis” for the management of Mr Clunis, if
he had not committed his index offence, would have been that he would probably
have lived in the community for the majority of the time subject to acute
exacerbations of his illness, perhaps requiring short admissions to hospital.
From time to time he would probably have defaulted from medication. His mental
state would have worsened and again he would have required short admissions to
hospital, assuming he would not have disappeared from contact with the
psychiatric services.”
The Defendant’s Application
For the defendant, Mr Grace Q.C. contends that the plaintiff’s
claim should be dismissed on two grounds. Firstly that the claim is based
substantially, if not entirely, upon his own illegal act which amounted to the
crime of manslaughter. Ex turpi causa non oritur actio . Secondly the
cause of action is alleged to arise out of the statutory obligations of the
defendant to provide aftercare following the plaintiff’s release from Guys
Hospital. The defendant contends that those obligations do not give rise to a
common law duty of care.
In answer, Mr Irwin Q.C. for the plaintiff contended that the
maxim ex turpi causa non oritur actio did not apply to causes of action
founded in tort. Even if it did, the court should look at the seriousness of the
offence to determine whether it was contrary to public policy that the plaintiff
should be allowed to maintain a cause of action. As to duty, the plaintiff was
still a patient who was in the care of the defendant authority and its doctors
and nurses. His relationship with the defendant was that of doctor and patient
which clearly gives rise to a duty of care. Even if that was not the
relationship between the plaintiff and the defendant authority, the obligations
imposed under the Mental Health Act 1983 created duties owed by the defendant
authority to a limited class, i.e. mental health patients, whom Parliament must
have intended should have a right to sue for breach of that duty. Failing that,
the obligations imposed by Parliament on the defendant gave rise to a duty of
care owed to him at common law.
Is the plaintiff’s action barred on grounds of public policy?
Mr Irwin submitted that the rule of policy embraced by the Latin
maxim ex turpi causa non oritur actio does not apply to causes of action
founded in tort and that the plaintiff’s cause of action does not arise from the
manslaughter of Mr Zito.
Of this maxim Lord Lindley in
Scott v Brown, Doering, McNab
& Co .
[1892] 2 QB 724 said:
“This old and well-known legal maxim is founded in good sense,
and expresses a clear and well recognised legal principle, which is not confined
to indictable offences. No court ought to enforce an illegal contract or allow
itself to be made the instrument of enforcing obligations alleged to arise out
of a contract or transaction which is illegal, if the illegality is brought to
the notice of the court, and if the person invoking the aid of the court is
himself implicated in the illegality. It matters not whether the defendant has
pleaded the illegality or whether he has not. If the evidence adduced by the
plaintiff proves the illegality the court ought not to assist him.”
The clear and well recognised legal principle to which Lord
Lindley referred has in the ensuing one hundred years become blurred by attempts
to rationalise its application to different types of claim and to mitigate its
consequences where they have appeared to the court to lead to a manifestly
unjust result or where the rights of innocent parties may be affected if it is
applied. Comparisons have been made between its application to cases in which
contractual rights are pursued, those in which property is claimed and those in
which other rights are in issue.
In Colburn v Patmore [1834] 1 CR, M, & R 73 at page
83, Lord Lyndhurst LCB said:
“I know of no case in which a person who has committed an act,
declared by the law to be criminal, has been permitted to recover compensation
against a person who has acted jointly with him in the commission of the crime.
It is not necessary to give any opinion upon this point; but I may say, that I
entertain little doubt that a person who is declared by the law to be guilty of
a crime cannot be allowed to recover damages against another who has
participated in its commission.”
The argument is even more pertinent if the claim to damages is
against someone who has not participated in the crime. The rule stated by Lord
Mansfield in
Holman v Johnson [1775] 1 Cowp 341 was a rule of public
policy that:
“A court will not lend its aid to a man who founds his cause of
action on an illegal or immoral act”.
The question in that case arose on a claim for goods sold and
delivered, but Lord Mansfield did not confine his principle to such cases.
We do not consider that the public policy that the court will
not lend its aid to a litigant who relies on his own criminal or immoral act is
confined to particular causes of action. Although Mr Irwin asserted that in the
present case the plaintiff’s cause of action did not depend upon proof that he
had been guilty of manslaughter, the claim against the defendant authority is
founded on the assertion that the manslaughter of Mr Zito was the kind of act
which Dr. Sergeant ought reasonably to have foreseen and that breaches of duty
by the defendant authority caused the plaintiff to kill Mr Zito. Further the
foundation of the injury, loss and damage alleged is that, having been convicted
of manslaughter, the plaintiff will in consequence be detained under the Mental
Health Act 1983 for longer than he otherwise would have been. In our view the
plaintiff’s claim does arise out of and depend upon proof of his commission of a
criminal offence. But whether a claim brought is founded in contract or in tort,
public policy only requires the court to deny its assistance to a plaintiff
seeking to enforce a cause of action if he was implicated in the illegality and
in putting forward his case he seeks to rely upon the illegal acts. As Best C.J.
said in Adamson v Jervis [1827] 4 Bin 66, 130 E.R. 693:
“From the inclination of the court in this last case, and from
the concluding part of Lord Kenyon’s judgment in Merryweather v Nixon,
and from reason, justice and sound policy, the rule that wrongdoers cannot
have redress or contribution against each other is confined to cases where the
person seeking redress must be presumed to have known that he was doing an
unlawful act.”
The restriction of the operation of the policy to cases in which
the person seeking redress must be presumed to have known that he was doing an
unlawful act was confirmed in the case of
Burrows v Rhodes and Jameson
[1899] 1 QB 816. In that case the court had to decide whether the plaintiff
could recover damages for deceit after he had been duped by the defendants into
joining in a military expedition led by one of the defendants into the Transvaal
(“the Jameson raid”) and who, had he known of the purpose for which he was
joining the expedition, would have been guilty of an offence under the
Foreign Enlistment
Act 1870. The defendants had argued that his action should be dismissed
as his case was founded on an illegal act. The court rejected the argument
because the plaintiff himself was innocent, had not been convicted and did not
have the necessary intention to be involved in the commission of the offence.
Kennedy J. at page 828 said:
“It has, I think, long been settled law that if an act is
manifestly unlawful, or the doer of it knows it to be unlawful, as constituting
either a civil wrong or a criminal offence, he cannot maintain an action for
contribution or for indemnity against the liability which results to him
therefrom ...
Where the circumstances constituting the unlawfulness of the act
are known to the doer of it, his inability to claim contribution or indemnity
appears to me to be clear.”
And at page 829:
“Certainly there is no right of indemnity where the doer of the
act which another has authorized or induced knows it at the time to be a
criminal offence. If, in a case in which knowledge is an essential ingredient of
the offence, the plaintiff, in his claim for an indemnity, admitted that he was
guilty of the offence, his claim would be on the face of it bad. If, in the like
case, he was, on the trial of his claim for indemnity, proved to have been
convicted of the offence, judgment must be given against him. Nor, in my
judgment, can there be any valid claim to indemnity where the doer of the act
which constitutes the offence has done it with knowledge of all the
circumstances necessary to constitute the act an offence, but in ignorance that
the act done under those circumstances constituted an offence. A man is presumed
to know the law.
Thirdly, although it is not necessary to decide the point, I am
inclined to think that there could be no valid claim to indemnity for being
authorized or induced to do an act where the act which is in fact criminal is
done in ignorance of the existence of some circumstance which is necessary to
make it a crime, or even is done in a belief that such circumstance does not
exist, but where it is known that the act is morally a wrong act. In such a case
the doer of the act has, it may be said, the mens rea in the sense attributed to
that expression by Bramwell B. in the well-known case of R. v Prince ...
But I am unable to accept the defendants’ proposition, where the
act, though a criminal offence - malum prohibitum - is, upon the state of facts
which the doer by the fraudulent misrepresentation of the person against whom he
claims indemnity has been induced to believe to be the true state of facts,
neither criminal nor immoral.”
Later he said at page 833:
“As I have already pointed out, it can never, in my judgment, be
successfully contended that a claim for indemnity can be maintained where the
doer of the act knew at the time, or must be presumed to know, of circumstances
which make the act either a private wrong or a public crime. Here the gist of
the case is that the plaintiff did not know the facts which made his conduct
criminal, but, on the contrary, was led by the defendants to believe, and did
believe, in the existence of the fact - the sanction of the British Government -
which, if it had been given, as he had a right (upon the defendants’
representation) to assume it had been given, in the proper way, namely, under
the licence of Her Majesty, would have been an answer to any imputation of
illegality.”
These principles seem to us to be relevant to Mr Irwin’s next
submission that not all criminal or illegal acts will prevent the court from
entertaining a plaintiff’s claim. Pertinently he said that there are today many
summary offences which are not sufficiently serious to warrant the invocation of
the maxim; the offence of manslaughter is an offence which varies greatly in its
moral blameworthiness, especially if the manslaughter is by reason of diminished
responsibility. He urged the court to say that, where the degree of
responsibility was diminished by reason of mental disorder, the court should not
apply the maxim. He prayed in aid in this regard a test which this court has
adopted in other cases between 1986 and 1994, namely whether the result in a
particular case would be acceptable to “the public conscience”.
In
Tinsley v Milligan [1994] 1 AC 340 Lord Goff, Lord
Keith and Lord Browne-Wilkinson regarded such a test as unsatisfactory. Lord
Goff preferred to accept the reason for the rule stated by Ralph Gibson L.J. in
the Court of Appeal in that case that, insofar as the maxim is directed at
deterrence, the force of the deterrent effect is in the existence of the known
rule and its stern application. Lord Goff said at page 363:
“But bearing in mind the passage from the judgment of Ralph
Gibson L.J. which I have just quoted, I have to say it is by no means
self-evident that the public conscience test is preferable to
the Act’s
present strict rules. Certainly I do not feel able to say that it would be
appropriate for your Lordships House, in the face of a long line of unbroken
authority stretching back over 200 years, now by judicial decision to replace
the principles established in those authorities by a wholly different
discretionary system.”
Lord Browne Wilkinson at page 369 said:
“My Lords, I agree with the speech of my noble and learned
friend, Lord Goff of Chieveley, that the consequences of being a party to an
illegal transaction cannot depend, as the majority of the Court of Appeal held,
on such an imponderable factor as the extent to which the public conscience
would be affronted by recognising rights created by legal transactions.”
In the present case the plaintiff has been convicted of a
serious criminal offence. In such a case public policy would in our judgment
preclude the court from entertaining the plaintiff’s claim unless it could be
said that he did not know the nature and quality of his act or that what he was
doing was wrong. The offence of murder was reduced to one of manslaughter by
reason of the plaintiff’s mental disorder but his mental state did not justify a
verdict of not guilty by reason of insanity. Consequently, though his
responsibility for killing Mr Zito is diminished, he must be taken to have known
what he was doing and that it was wrong. A plea of diminished responsibility
accepts that the accused’s mental responsibility is substantially impaired but
it does not remove liability for his criminal act. We do not consider that in
such a case a court can or should go behind the conviction and, even if it
could, we do not see in the medical report attached to the statement of claim
any statement which would justify the court taking the view that this plaintiff
had no responsibility for the serious crime to which he pleaded guilty.
The plaintiff in this case, though his responsibility is in law
reduced, must in Best C.J.’s words be presumed to have known that he was doing
an unlawful act.
The only case cited to us to suggest that the court would
entertain a claim to recover damages based on a plaintiff’s conviction of a
criminal offence knowingly committed is Meah v McCreamer (No. 1) [1985] 1
AER 367. In that case the plaintiff who had suffered a head injury in a road
accident was held to be entitled to damages which arose from his subsequent
conviction of two offences of rape. Subsequently, in Meah v McCreamer (No. 2)
[1986] 1 AER 983, he was held not to be entitled to claim as damages sums he
had been ordered to pay in compensation to the victims of the rapes. At the
first hearing the judge, Lord Woolf then Woolf J., recorded that it had not been
argued on behalf of the defendant that the plaintiff was not entitled to be
compensated for having committed the crimes and was entitled to receive
substantial damages in respect of that claim (see page 371(j)). At the second
hearing it was argued that it would be contrary to public policy for the
plaintiff to be indemnified in respect of the consequences of his crimes (see
page 950(h)). Basing himself on the judgment of Lord Denning M.R. in Gray v
Barr [1971] 2 QB page 554 at page 568, Lord Woolf held that public policy:
“... would be a further ground for holding that the plaintiff is
not entitled to be indemnified for his criminal attacks on the two ladies
concerned.”
Whilst any decision of Lord Woolf must be given the greatest
weight, we do not consider that, in the absence of argument on the issue of
public policy, his decision in Meah v McCreamer (No. 1) (supra) can be
regarded as authoritative on this issue.
In Gray v Barr (supra) a defendant who had shot and
killed the plaintiff’s husband in circumstances amounting to manslaughter,
though acquitted of the criminal offence, was held to be precluded from claiming
indemnity under a policy of insurance. Lord Denning M.R. at page 568 emphasised
that in manslaughter of every kind there must be a guilty mind. He held that if
the defendant’s conduct was wilful and culpable he was not entitled to recover.
In the present case we consider the defendant has made out its
plea that the plaintiff’s claim is essentially based on his illegal act of
manslaughter; he must be taken to have known what he was doing and that it was
wrong, notwithstanding that the degree of his culpability was reduced by reason
of mental disorder. The court ought not to allow itself to be made an instrument
to enforce obligations alleged to arise out of the plaintiff’s own criminal act
and we would therefore allow the appeal on this ground.
The defendant authority’s duty.
The next question for the court is the nature and extent of any
obligation or duty owed by the defendant health authority to the plaintiff and
whether a breach of such duty can give rise to a claim for damages.
The duty to provide after care which is at the heart of the
plaintiff’s claim and his submissions arises under sec. 117 of the Mental Health
Act 1983. Sec. 117 provides:
“(1) This section applies to persons who are detained under sec.
3 above ... and then cease to be detained and leave hospital.
(2) It shall be the duty of the district health authority and of
the local social services authority to provide, in co-operation with relevant
voluntary agencies after care services for any person to whom this section
applies until such time as the district health authority and the local social
services authority are satisfied that the person concerned is no longer in need
of such services.
(3) In this section the district health authority means district
health authority for the district and “the local social services authority”
means the local social services authority for the area in which the person
concerned is resident or to which he is sent on discharge by the hospital in
which he was detained.”
The Act also provides by sec. 124 for the Secretary of State to
exercise enforcement powers where an authority is in default:
“(1) Where the Secretary of State is of opinion on complaint or
otherwise that a local social services authority have failed to carry out
functions conferred or imposed on the authority by or under this Act or have in
carrying out the functions failed to comply with any regulations relating to
those functions, he may after such enquiry as he thinks fit make an order
declaring the authority to be in default.
(2) Subsections (3)-(5) of sec. 85 of the National Health
Service Act 1977 (which relates to orders declaring, among others, a local
social services authority to be in default under that Act) should apply in
relation to an order under this section as they apply in relation to an order
under that section.”
Following the analysis of the duties imposed by Parliament on
local authorities in
X v Bedfordshire County Council & Ors .
[1995] 2 AC 633, the first question is whether the statutory provisions in this case
create duties which give rise to a private law claim for damages if they are not
fulfilled or, more particularly, whether a person who has been detained in
hospital and who is discharged can claim damages for non-performance of the
“after care” obligations in sec. 117(2) of the Act.
Under sec. 117(2) the authorities named are required to
co-operate with voluntary organisations in setting-up a system which provides
after care services for patients who have been discharged from hospital after
treatment for mental disorder. The services have to be made available to such
persons until “the person concerned is no longer in need of such services”.
Undoubtedly the section is designed to promote the social welfare of a
particular class of persons and to ensure that the services required are made
available to individual members of the class. However sec. 124 provides the
Secretary of State with default powers if he is of the opinion “on complaint or
otherwise” that the functions conferred or imposed under the Act have not been
carried out. Thus the primary method of enforcement of the obligations under
sec. 117 is by complaint to the Secretary of State. No doubt, too, a decision by
the district health authority or the local social services authority under the
section is liable to judicial review at the instance of a patient, see R. v
The Ealing District Health Authority, Ex Parte Fox [1993] 3 AER 170. The
character of the duties created seem to us closely analogous to those described
by Lord Browne-Wilkinson in X (Minors) v Bedfordshire C.C . (supra) at
page 747 as requiring:
“... exceptionally clear statutory language to show a
parliamentary intention that those responsible for carrying out these difficult
functions should be liable in damages if, on subsequent investigation with the
benefit of hindsight, it was shown that they had reached an erroneous conclusion
and therefore failed to discharge their statutory duties.”
In our view the wording of the section is not apposite to create
a private law cause of action for failure to carry out the duties under the
statute.
Mr Irwin argued that, on discharge from hospital, the patient
nevertheless remained a person for whom the district health authority and the
local social services authority are responsible in the sense that they have a
duty not only to ensure that the services are available but that the patient
receives the benefit of them and he went on to submit that a duty of care is
thereby imposed on the authority which is merely an extension of the care which
he has been receiving as a patient in hospital. In effect, he submitted, the
relationship of doctor and patient which existed between the district health
authority and the plaintiff while he was in hospital continued after discharge,
so that a common law duty of care was owed by the defendant to continue the
plaintiff’s treatment. Is it in the circumstances just and reasonable to
superimpose such a common law duty of care on an authority in relation to the
performance of its statutory duties to provide after care? We do not think so.
We find it difficult to suppose that Parliament intended to create such an
extensive and wide-ranging liability for breaches of responsibility under sec.
117 which would of its nature apply alike to those engaged as professionals as
well as those in voluntary services in many disciplines.
After care services are not defined in the Act. They would
normally include social work, support in helping the ex-patient with problems of
employment, accommodation or family relationships, the provision of domiciliary
services and the use of day centre and residential facilities. No doubt an
assessment of the patient’s needs would in the first instance be made by the
hospital which discharged him. It was for that purpose in this case that the
defendant authority sought to arrange appointments with the plaintiff. In that
respect, its actions through Dr. Sergeant were essentially in the sphere of
administrative activities in pursuance of a scheme of social welfare in the
community. Bearing in mind the ambit of the obligations under sec. 117 of the
Act and that they affect a wide spectrum of health and social services,
including voluntary services, we do not think that Parliament intended so
widespread a liability as that asserted by Mr Irwin. The question of whether a
common law duty exists in parallel with the authority’s statutory obligations is
profoundly influenced by the surrounding statutory framework. See per Lord
Browne-Wilkinson in
X v Bedfordshire at page 739C, and per Lord Hoffmann
in
Stovin v Wise [1996] AC 923 at 952F-953A. So, too, in this case, the
statutory framework must be a major consideration in deciding whether it is fair
and reasonable for the local health authority to be held responsible for errors
and omissions of the kind alleged. The duties of care are, it seems to us,
different in nature from those owed by a doctor to a patient whom he is treating
and for whose lack of care in the course of such treatment the local health
authority may be liable.
Nor do we think that Dr. Sergeant should be held liable for a
failure to arrange for a mental health assessment more speedily. The suggestion
that because local police had reported that the plaintiff was waving
screwdrivers and knives about and talking about devils illustrates to our mind
the difficulty of holding her responsible in this case. Under sec. 136 of the
Mental Health Act a constable finding a person in a public place who appears to
be suffering from a mental disorder and to be in immediate need of care or
control may:
“If he thinks it necessary to do so in the interests of that
person or for the protection of other persons, remove that person to a place of
safety ...”
We doubt if even this language, though specifically requiring
the constable to act in the interests of a mentally disordered person, creates a
duty to take care which gives rise to a claim for damages at the suit of the
disordered person.
Moreover as Lord Browne-Wilkinson pointed out in X v
Bedfordshire (supra), the question whether a doctor owes a duty of care to a
patient in certifying that a patient is fit to be detained under the Mental
Health Acts was left undecided in Everett v Griffiths [1920] 3 KB 163
[1921] 1 AC 361 and still remains open for decision in an appropriate case. We
have no doubt that it would not be right to hold Dr. Sergeant or the defendant
health authority liable to the plaintiff in damages for failure to arrange the
plaintiff’s assessment for the purposes of sec. 117 more speedily than she did.
For these reasons we do not think the plaintiff can establish a
cause of action arising from a failure by the defendant health authority or Dr.
Sergeant to carry out their functions under sec. 117 of the Mental Health Act.
Nor do we think that it would be fair or reasonable to hold the defendant
responsible for the consequences of the plaintiff’s criminal act.
In our view the defendant’s application should have succeeded on
both grounds and we would allow the appeal.
ORDER: Appeal allowed, order below set aside; costs below to be
the defendants, not to be enforced without leave; order nisi against the Legal
Aid Board in relation to the costs of the appeal; leave to appeal to the House
of Lords refused.