QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Strand London WC2 |
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B e f o r e :
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THE QUEEN ON THE APPLICATION OF B | Claimant | |
-v- | ||
SOUTH REGION MENTAL HEALTH REVIEW TRIBUNAL | Defendant | |
and | ||
(1) BROADMOOR SPECIAL HOSPITAL | ||
(2) THE SECRETARY OF STATE FOR THE HOME DEPARTMENT | Interested Parties |
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Mr Matthew Barnes (instructed by Treasury Solicitor, London WC2B 4TS) appeared on behalf of the Defendant
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"While he lacks insight into his illness and his need for medication to alleviate it, the likelihood and risks of non-compliance with medication and of deterioration of his mental state, should he be discharged into the community, and of dangers to others, are not acceptable. The Tribunal considers that [the claimant] has been relatively stable recently and might be appropriately managed in medium security. The Tribunal considers that the Authority should review putting him forward for transfer."
The grounds in detail
Grounds 1 to 3
"13. In reaching that view, we considered that: (i) the hearing would continue to be heard in private, as the nurse was there not as a member of the public but for the purpose of informing the clinical team; (ii) it is normal practice that member(s) of a clinical team treating the patient are present throughout MHRT hearings; (iii) the Claimant had a right and opportunity to supplement the evidence he gave in the presence of a member of the clinical team, by speaking to the Tribunal in private; and (iv) the Claimant's objection to a member of his clinical team hearing his evidence was unreasonable as his answers and demeanour might help the clinical teams' understanding of him. For the avoidance of any doubt, the hearing was conducted in private under Rule 21 (paragraph 1). The patient gave his evidence in the absence of any member of the public under Rule 22(4), the nurse being present as a member of the clinical team. The patient also later exercised his right under Rule 22(2) to speak to the tribunal in the absence of the nurse and of anyone else except his legal team."
"The Tribunal considered that it was desirable that a member of the clinical team should be present during questioning of the patient by the Tribunal, in particular by the Medical Member, because the patient had declined to be interviewed by the current RMO and, for disputed reasons, had not had any 1:1 sessions with his current Primary Nurse.
The Tribunal invited the attending nurse from the team to hear the remainder of the patient's evidence even though the patient said he would prefer that the nurse was not present and his counsel contended that the Tribunal had no power to authorise the presence of the nurse for the purpose of hearing the evidence. Most of the questioning of the Tribunal was heard by one and then another nurse."
"21(1) The tribunal shall sit in private unless the patient requests a hearing in public and the tribunal is satisfied that a hearing in public would not be contrary to the interests of the patient.
...
(3) When the tribunal sits in private it may admit to the hearing such persons on such terms and
conditions as it considers appropriate.
(4) The tribunal may exclude from any hearing or part of a hearing any person or class of persons, other than a representative of the applicant or of the patient to whom documents would be disclosed in accordance with rule 12(3), and in any case where the tribunal decides to exclude the applicant or the patient or their representatives or a representative of the responsible authority, it shall inform the person excluded of its reasons and record those reasons in writing."
"22(1) The tribunal may conduct the hearing in such manner as it considers most suitable bearing in
mind the health and interests of the patient and it shall, so far as appears to it appropriate, seek to
avoid formality in its proceedings.
(2) At any time before the application is determined, the tribunal or any one or more of its members may interview the patient, and shall interview him if he so requests, and the interview may, and shall if the patient so requests, take place in the absence of any other person.
...
(4) Subject to rule 21(4), any party and, with the permission of the tribunal, any other person, may appear at the hearing and take such part in the proceedings as the tribunal thinks proper, and the tribunal shall in particular hear and take evidence from the applicant, the patient (where he is not the applicant) and the responsible authority who may hear each other's evidence, put questions to each other, call witnesses and put questions to any witness or other person appearing before the tribunal."
(a) There were three potential outcomes to the hearing — the presence of a medical member of the team would be relevant not only to the claimant remaining in hospital, but also if he were released conditionally and even arguably if he were released absolutely. Given that there had been no recent opportunity for the team to observe him, an up-to-date assessment of him could only be helpful whatever the outcome.(b) Counsel did not challenge the Tribunal on the basis of bias or appearance of bias when it came to its decision. If it was so obviously biased, as has been asserted by the claimant, then one would have expected some submissions to that effect at the time.
(c) The witness statement of the claimant's solicitor prepared for this hearing also does not suggest that the Tribunal had prejudged the issue or indicated bias.
(d) The fact that a decision was taken contrary to the representations made by one side does not mean that there is an appearance of the Tribunal being partial to the other side.
(e) The committee referred to various parts of the claimant's evidence in the decision which they could not have summarised until the end of the claimant's evidence, as he gave evidence for the whole of the morning of the day in question.
(f) The hearing was still in private and, moreover, the claimant had the opportunity to address the committee in the absence of the nurse.
(g) It is normal practice for members of the clinical team to be present during such hearings.
(h) There is nothing in the decision which gives rise to any justified complaint that the presence of the nurse in any way affected the decision or indeed the view they took of the claimant's evidence.
It is not arguable that a fair-minded observer in possession of the relevant facts would consider the Tribunal to have been biased.
Ground 4
"16. We had also discussed what each of us considered significant in the process of evolution of our assessment. After counsel for the Claimant had completed her closing address, none of us considered that she had raised issues we had not already considered and reached provisional views on. Counsel had explored very thoroughly the issues during oral evidence and her closing address contained no surprises. We would have reviewed the evidence further if any of us had considered this was needed in the light of counsel's closing address, or Dr Al-Yassiri or Mr Holley wanted to review any aspect of the evidence or issues on which we had reached provisional agreement.
17. I do not recall the actual words I used when stating that we would not announce the decision on the day. Nor do I remember what I further said when counsel for the Claimant sought to persuade us to announce on the day so, when I had already said we would not. While we had reached provisional conclusions, I could not be confident that counsel's final address might not have caused either Dr Al-Yassiri or Mr Holley to want to further review our provisional conclusions. The case was extremely complex and our discussion of the issues had been extensive. Also I knew that during the course of editing the existing draft for the Decision Form I might discover that my notes of what we had provisionally agreed were not sufficiently clear and needed further discussion.
18. On reaching the end of our discussions after the submissions made by counsel for the Claimant, I still needed to word process what we had agreed, and I was conscious that I would have needed to consult the other Members before completing the Decision Form if, when I later word processed what we had agreed, I discovered that my notes needed clarification as to what we had agreed. This did not prove to be the case but given the complexity of the case it might have. In any event, I had incorrectly assumed that the Claimant and his counsel had reluctantly accepted that we would not announce our decision on the day, and had departed."
Ground 5 is divided into seven subsections
Ground 5(a)
Ground 5(b)
Ground 5(c)
Ground 5(d)
Grounds 5(e) to (g)
Ground 5(a), the Tribunal did consider the issue of a conditional discharge and came to the conclusion that it was not appropriate. That is reflected in page 16 of the decision, although it is accepted that it is implicit rather than explicit in the reasons;
Ground 5(b), they relied on the earlier decision for the narrative history only.
Ground 5(c), their reasons, although briefly stated, reflected why they found that the two witnesses did not carry sufficient weight to alter the substance of the accumulated medical evidence adduced by the hospital.
Grounds (d) to (g), they gave extensive thought to the issue of mental illness, guided by the medical member of the Tribunal and gave adequate reasons for their conclusions. Their conclusions are to be found at paragraph 30 of the statement of the chair, where he sets out in summary that the Tribunal considered that:
"(i) the Claimant was suffering from a mental illness of a nature and degree which made it appropriate for him to be detained in a hospital for medical treatment; and (ii) it was necessary for the mental health or safety of the Claimant and for the protection of other persons that he should receive such treatment."
Ground 5(a)
Ground 5(b)
"The present Tribunal, differently constituted, has accepted paras B1 to B6 of the earlier decision as accurate narrative of the history, while making a fresh and independent assessment and decision on the evidence in September 2007."
The claimant has not shown how it may have affected the decision reached, nor that it was an unreasonable course to take, nor the alleged inaccuracies identified.
Ground 5(c)
"The Tribunal concludes that HCA Charman's view that there has been nothing inappropriate in [the claimant's] behaviour reflects his limited responsibility in management of [the claimant] towards whom Mr Charman represents no challenge in relation to therapeutic engagement. Primary Nurse Pauline Tutani-Lewis has not been able to engage [the claimant] in any form of therapeutic work and so [the claimant] has succeeded in avoiding addressing his actual mental health challenges or issues with her: so her opportunity to assess his diagnosed underlying mental illness has been frustrated. Even so, [the claimant] told the Tribunal that his P.N. had given inaccurate evidence saying that he had avoided 1:1 therapeutic sessions — he says he has been willing to do this and it was she who refused."
Ground 5(d)
Grounds 5(e) to (g)
(a) This point has been dreamt up at the last minute with no reason given as to why it has been left until the last moment if it really was considered to be a point with merit;
(b) The defendant is prejudiced. While it is said that the other Tribunal members had seen a copy of Judge Fricker's statement and agreed with it, it was not considered necessary to take statements from them. A point like this would require statements to be taken from each member of the Tribunal. This was not possible due to the lateness of the point being raised.
(c) It is clear from the document and from the evidence of Judge Fricker that when the members of the Tribunal left the hearing they were agreed and had to come to a decision. The effect of Judge Fricker's statement is that the committee had an original draft of issues and that were given only parts where substantial amendments were made during the course of the hearing as a result of their discussions. When they left on the Friday, they were agreed about their decision and the reasons. The rest was tidying up by Judge Fricker of the reasons and the presentation of the document. There is no requirement that all three members sign the decision document, and it had also to borne in mind in this jurisdiction the chairman has a decisive role to play.