R (Jenkins) v HM Coroner for Portsmouth and South East Hampshire and Cameron and Flynn (interested parties) [Administrative Court]
| Jurisdiction | England & Wales |
| Judgment Date | 11 December 2009 |
| Date | 11 December 2009 |
| Court | Queen's Bench Division (Administrative Court) |
Administrative Court, CO/1368/2009
Pitchford J
R Birch (instructed by Blake Lapthorne) for the claimant; C McGahey (instructed by Hampshire County Council) for the defendant; S Butler for the first interested party.
Whether a verdict of gross negligence manslaughter should have been returned where a person had complied with the deceased's refusal to accept medical help; whether the coroner could reasonably have come to the conclusions he did on the evidence.
The deceased had injured his left foot and developed an infection in the wound, which became gangrenous and was ultimately fatal. He was an ardent believer in alternative medicine, did not seek medical attention for his injury and refused to agree to his partner, C, and a homeopath (the interested parties) from doing so on his behalf. Medical evidence at the inquest was that had the deceased received timely conventional medical treatment the deceased would not have died. Further, if medical assistance had been sought towards the last hours of life, at a time when the deceased was drifting in and out of consciousness, there would have been a 10%-30% chance of survival.
The coroner returned a narrative verdict finding that neither the deceased nor anyone else on his behalf had sought conventional medical advice or treatment for his condition, and that in consequence the condition was inappropriately and ineffectively treated by the deceased and by others and this led to his death. The coroner concluded that C had no duty to summon help against the express wishes of the deceased and that the deceased may have been able to make his wishes known during his last hours. The claimant, the sister of the deceased, applied for judicial review of the coroner's verdict, arguing that the narrative verdict was perverse and that a verdict of unlawful killing should have been returned on the basis of manslaughter by gross negligence on the part of C.
1. This is a challenge with the permission of the single judge to the verdict of HM Coroner for Portsmouth and South East Hampshire who, on 13 November 2008, inquired into the death of Russell Anthony Neal Jenkins. The coroner returned a narrative verdict in the following terms:
"In late December 2006 Russell Anthony Neal Jenkins stepped on a plug of an electrical appliance in his home, injuring his left foot. He developed an infection in the wound of his foot which did not resolve itself and developed ultimately into gangrene. His condition deteriorated, particularly so in the last few days and hours of his life and, on 16 April 2007, he lapsed into an unconscious state and died during the night of 16/17 April 2007 at his home. At no stage following the injury to his foot did Russell Jenkins or anyone else on his behalf seek to obtain conventional medical advice or treatment for his condition. In consequence, Russell Jenkins' condition was inappropriately and ineffectively treated by himself and by others and this led to his death."
2. The claimant challenges the coroner's verdict on the ground that his verdict was perverse. It is the claimant's case that the only rational verdict would have been that the deceased was unlawfully killed, the
foundation for such a verdict being manslaughter by the gross negligence of Cherie Elizabeth Cameron.
3. Ms Cameron, the first interested party, was represented before me, as were the claimant and the defendant. The second interested party did not appear and has taken no part in the proceedings.
4. It is common ground that before the coroner could return a verdict of unlawful killing on the ground proposed he would have to be sure that:
(1) Ms Cameron owed a duty of care towards Mr Jenkins;
(2) Ms Cameron was in breach of that duty of care;
(3) The act or omission which constituted the breach of duty was a significant cause of death;
(4) Ms Cameron's negligence was criminal in quality.
5. I have been provided with the statements submitted to the coroner and the transcript of the hearing before him. The principal witnesses at the inquest were:
Mrs Elaine Jenkins, the deceased's mother,
Robert Jenkins, the deceased's brother,
Michael Cooter, a friend of the deceased,
Susan Finn, a homeopath and friend of the deceased,
Cherie Cameron, the deceased's partner,
Dr Dale, the deceased's general practitioner,
Mr Mark Pemberton, consultant vascular surgeon, and
Dr Guy Cunliffe, general practitioner who attended the body after death.
6. Mr Jenkins was a 52 year old man who was born in Merthyr Tydfil. In his early years he worked in a family business and then in London as a credit controller. He moved to Southsea in the 1980s where he started a wine bar and, latterly, lived, owned and worked at The Quiet Mind Centre at 32 Lorne Road. His parents now live in Cardiff and his brother Robert lives in Spain. Mr Jenkins died shortly after midnight on Tuesday 17 April 2007. The autopsy, conducted by Dr David Poller, revealed that the deceased had suffered from an ulcer about 2.8 cms in size on the sole of his left foot. The foot and lower leg became gangrenous and the left leg was swollen. Mr Jenkins was diabetic and suffered undiagnosed ischemic heart disease. His condition could have resulted in poor circulation to the extremities which may have assisted skin necrosis and gangrene. Mr Jenkins developed septicaemia (infection in the blood stream) which spread rapidly, caused unconsciousness, and finally resulted in death. Had he received timely conventional medical treatment with antibiotic medicine and debridement of the dead tissue, or amputation, Mr Jenkins would have made a substantial recovery.
Evidence at the inquest
7. The story which emerged in the evidence was an unusual one the nature of which the coroner had never before encountered. Mr Jenkins' diabetes was diagnosed in 1996. He attended his GP's practice from time to time for advice and medication. He was sent regular reminders for check ups but from the end of 2001 he ceased to use conventional NHS services. After his death there was found in his home medicine for his diabetic condition prescribed in 2001 but unused. He had during 2001 received advice from his GP about the dangers of diabetic neuropathy, particularly as it affected the feet. He was told that ulcers and any breaking of the skin could be dangerous but would be effectively dealt with by antibiotics. He was advised that any break in the skin should be reported promptly for treatment. The surgery was aware of Mr Jenkins' interest in alternative medicine and Dr Dale had visited him at his clinic at The Quiet Mind Centre. There, Mr Jenkins offered treatments of Reiki, aromatherapy and reflexology. Mr Jenkins never told his family about his diabetes.
8. Michael Cooter met Mr Jenkins in 1992 and became a regular visitor to The Stable Centre in Titchfield where Mr Jenkins led a meditation class. Mr Cooter followed him to classes at the Quiet Mind Centre. Mr Cooter regarded himself as a close friend. He described Mr Jenkins as a benevolent, compassionate and inspiring person. Mr Jenkins believed in personal development by concentrating upon the inner self. He believed that physical ailments were symptomatic of emotional turmoil. His treatments were intended to address spiritual well being. His spiritual life was very important to him. He developed a technique which witnesses described at 'checking' or 'dousing'. This was a state of mind induced in order to receive answers or approval from his inner being to a proposal or a course of action. A signal that he was engaged in this process was a movement of his fingers. Mr Jenkins did not disclose to Mr Cooter, either, that he was a diabetic.
9. Catherine Smiles had known Mr Jenkins since 1994. She attended his classes and later did secretarial work for him by way of payment. Mr Jenkins told her that when consulting his inner self he would experience a sensation in his right middle finger. As time went on Mr Jenkins became more and more absorbed in this process and had implicit trust in it. In her view Mr Jenkins was a fatalist. Ms Smiles suffered from ME and consulted Mr Jenkins about it. He said it was part of her "path" and if it was "meant" to get better it would.
10. Susan Finn is a homeopath who knew Mr Jenkins for about 18 years before his death. She had a friend called Jeannette who stayed at the Quiet Mind Centre for a time. She had attended Mr Jenkins' classes with
her husband in 2004 and was an occasional visitor. Mrs Finn would recommend homeopathic remedies for her friend Jeannette and Jeannette would ask Mr Jenkins to "check" them for her.
11. Cherie Cameron is a Registered General Nurse who spent the 12 years of her professional career as a nurse in operating theatres in Portsmouth and Southampton. She met Mr Jenkins in 2000 as a client. She attended meditation classes, and learned about energy healing and flower essences. In 2002, when her marriage broke down, Ms Cameron moved into the Quiet Mind Centre, at first as a tenant. She continued to work as a nurse until 2004 but then ceased conventional nursing to concentrate upon alternative therapies. A close personal relationship developed between Ms Cameron and Mr Jenkins and they called themselves partners. He told her that he was a borderline diabetic. Throughout their time together Mr Jenkins never consulted his GP and took no conventional medicines except, on one occasion according to Mr Cooter, ibuprofen, but early on he did see a homeopathic doctor, Dr Kenyon. Ms Cameron confirmed Mr Jenkins' trust in his...
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