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NHS trust not liable for suicide of voluntary mental health patient

29 June 2010

An NHS trust was not liable under human rights laws for the suicide of a voluntary mental health patient, the Court of Appeal has ruled.

The parents of Melanie Rabone claimed that, by allowing her to leave hospital and commit suicide, Pennine Care NHS Trust had violated their daughter’s right to life under article 2 of the ECHR.

However, the appeal judges drew a clear distinction between this case and the House of Lords ruling in Savage, where the patient involved was sectioned under the Mental Health Act (see Solicitors Journal 154/17, 4 May 2010).

Giving the leading judgment in Rabone and Rabone v Pennine Care NHS Trust [2010] EWCA Civ 698, Lord Justice Jackson said Melanie, aged 24, agreed to her informal admission to Stepping Hill Hospital after a suicide attempt.

“Melanie was asked by the nursing staff why she had rung her family asking to ‘get her out’, and responded by saying she had not been sleeping well due to disturbance from another patient,” Jackson LJ said.

“She expressed the wish to go out the next day with her parents, and was told that she could provided they agreed.”

Melanie left the ward with her mother for two days’ home leave. Having spent most of the first day with her mother, she said she was going to see a friend but instead hung herself from a tree in a local park.

The NHS trust paid £7,500 in damages to Melanie’s parents under the Law Reform Act as part of a settlement in 2008. The following year the trust admitted it had breached its common law duty of care to Melanie by granting her home leave and the chief executive apologised in a letter to her parents.

Mr Justice Simon, sitting at the High Court in Manchester, rejected the parents’ claim under article 2 of the ECHR (right to life).

“Having reviewed the authorities and considered counsel’s submissions, I have come to the conclusion that detention under the Mental Health Act makes a critical difference,” Jackson LJ said.

“It is clear that ECHR article 2 does not impose upon the state an operational obligation towards all persons who are at ‘real and immediate risk’ of death.

“For example, state officials are not obliged to stop those with suicidal intent from travelling to Switzerland: see Lord Scott in Savage at paragraph ten. In addition to the ‘real and immediate risk’ of death, there must be some additional element before state authorities come under the operational obligation.”

Jackson LJ said examples of an additional element were the involvement of the police with a criminal who is liable to kill the individual concerned or the fact that the individual is detained by the state.

Lord Jackson agreed with Mr Justice Simon that, since the parents had already obtained “effective redress” through damages, they could not be considered “victims” under article 34 of the ECHR.

Lord Justices Rix and Stanley Burnton agreed that the parents’ appeal should be dismissed.

Emma Holt, head of clinical negligence at Pannone, said the Court of Appeal’s decision was “policy-based” and she would be seeking leave to appeal to the Supreme Court.

“During the original trial, both parties’ experts agreed that the doctor’s decision to allow Melanie to leave was negligent,” she said.

“Her request should have been refused and if she had insisted on leaving she would have been compulsorily detained under the Mental Health Act.”

A spokeswoman for Pennine Care Trust said the trust recognised that Mr and Mrs Rabone had suffered a “devastating loss” but it was necessary to defend their claim “because it raised significant legal issues for the NHS”.

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