R (Takoushis) v HM Coroner for Inner North London and Others
| Jurisdiction | England & Wales |
| Judgment Date | 30 November 2005 |
| Neutral Citation | [2005] EWCA Civ 1440 |
| Docket Number | Case No: C1/2005/0056 |
| Court | Court of Appeal (Civil Division) |
| Date | 30 November 2005 |
[2005] EWCA Civ 1440
Sir Anthony Clarke Mr
Lord Justice Chadwick
Lord Justice Moore-Bick
Case No: C1/2005/0056
IN THE SUPREME COURT OF JUDICATURE
COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM THE HIGH COURT OF JUSTICE
ADMINISTRATIVE COURT
The Hon Mr Justice Elias
Royal Courts of Justice
Strand, London, WC2A 2LL
Mr Edward Fitzgerald QC and Ms Ruth Brander (instructed by Scott-Moncrieff Harbour and Sinclair) for the Appellant
Mr Clive Lewis (instructed by Camden Legal Services) for the First Respondent
Mr Iain Daniels (instructed by Guys and St Thomas' Hospital Trust) for the Second Respondent
Mr Gerard Boyle (instructed by the Director of Legal Services) for the Third Respondent
Sir Anthony Clarke, MR:
Introduction
This is the judgment of the court on an appeal, brought with the permission of the judge, from an order made by Elias J on 16 December 2004. By that order he dismissed an application for judicial review of two decisions made by the first respondent, the Coroner for Inner North London ("the coroner"), who has both legal and medical qualifications. The decisions were made in the course of an inquest which took place on 3 and 4 March 2004 into the death of Mr Pavlos Takoushis, who was a man of 64 years of age whose body was found in the River Thames on 14 February 2003. The application was made by his widow, Mrs Helen Takoushis. The second respondent, the Guys and St Thomas' NHS Trust, took part as an interested party. We will call the second respondent "the trust". References below to "the hospital" are references to St Thomas' Hospital. The coroner put evidence before the judge but was not represented before him. He has been represented before us by Mr Clive Lewis. The trust was represented before the judge and before us by Mr Iain Daniels. The Metropolitan Police was an interested party before the judge but, although counsel was present during the hearing of the appeal, he played no significant part in it.
In the course of the inquest Ms Ruth Brander made two applications to the coroner on behalf of the family which were refused. Those refusals formed the basis of the application for judicial review to the judge. The first was an application based upon section 8(3)(d) of the Coroners Act 1988 ("the 1988 Act") that the inquest should be before a jury and the second was an application that the inquest should be adjourned in order to enable the family of the deceased to take expert advice with a view to the opinion of an expert being put in evidence. In this appeal the appellant submits that both those decisions were wrong in law and that the judge should have so held.
It is fair to say that the argument in this appeal has ranged over wider ground than that before the judge. Before the judge it was assumed that article 2 of the European Convention on Human Rights ("the ECHR") was engaged, whereas before us the coroner, who was not represented before the judge, submitted that that assumption is wrong. In these circumstances the argument on the appeal fell into two broad parts. The first addressed the question whether the refusals complained of were justified on the assumption that article 2 was not engaged and the second addressed the question whether article 2 was engaged. We propose to approach the matter in the same way.
The facts
The facts are not for the most part in dispute and, to a considerable extent, can be taken from the clear exposition of them in the judge's judgment. The deceased, Pavlos Takoushis, was the husband of the claimant. He was a long-term schizophrenic who had been treated periodically in psychiatric hospitals, both voluntarily and involuntarily, since he was first diagnosed with the illness in 1974. On 9 January 2003 he was admitted to Chase Farm Hospital as a voluntary psychiatric patient. At about 1115 on 13 January he obtained permission to leave the ward to visit the day hospital within the hospital grounds. He did not return. The ward manager became concerned because he had left without a jacket, which was an odd thing to do, given that it was cold outside.
He was next seen at about midday apparently preparing to jump off Tower Bridge. He had his legs over the parapet of the bridge and he was being pulled back from the edge by an American tourist. This was witnessed by a member of the public who was passing, Mr Jeff Wilcox. Mr Wilcox was concerned by Mr Takoushis' behaviour and decided to follow him. He spoke to Mr Takoushis and asked him if he was OK. He was told to go away. After Mr Takoushis had made several more approaches towards the river edge, Mr Wilcox decided to call the emergency services.
Police arrived, followed by an ambulance crew. Mr Wilcox told the officers what he had seen. PC Prole spoke to Mr Takoushis and suggested that he go to hospital. Mr Takoushis agreed. PC Prole stated in his evidence at the inquest that he was concerned about Mr Takoushis' safety at that point and said that, if Mr Takoushis had not agreed to go to the hospital voluntarily, he would have considered using his powers to detain him and remove him to a designated place of safety under section 136 of the Mental Health Act 1983. In the event it was not necessary to do so.
Mr Takoushis informed one of the other officers present that he was taking a drug for his illness. (He apparently said that it was "Promazone" but presumably meant Promazine, a low-potency anti-psychotic medication.) He did not, however, mention that he was currently an in-patient at the Chase Farm Hospital.
Mr Takoushis was then taken by ambulance to St Thomas' Hospital Accident and Emergency Department. The information regarding Mr Takoushis' medication was not passed on to the ambulance crew. He was described by a member of the ambulance crew, Mr Michael Smith, as being calm, alert and orientated but he refused to allow his blood pressure to be taken. He told Mr Smith that he was intending to jump into the river because he had had an altercation that morning with his wife, during which she had accused him of having an affair and told him to throw himself in the river. He denied having tried to commit suicide in the past and, when asked, denied that he would try again in the future because he saw no point.
It should be noted that there was other evidence that Mrs Takoushis had not spoken to her husband that morning and (as stated in Paragraph 30 below) the coroner was satisfied that what Mr Takoushis said about being told to jump into the river by his wife was a delusion.
Mr Takoushis arrived at St Thomas' A&E at about 1300. The ambulance staff explained to Staff Nurse Blake, who was the triage nurse on duty at that time, that Mr Takoushis had been found trying to jump off Tower Bridge. Nurse Blake took Mr Takoushis to a cubicle used for patients with potential mental health problems.
The trust had a system in place for assessing the needs of patients who present themselves at the A&E department. This was based on a document called Emergency Triage which was produced by the Manchester Triage Group. It involves the clinical prioritisation of patients including those with mental health problems and includes a flowchart, which identifies five categories of priority with differing target times for the patient to be seen. The times vary from immediate to 240 minutes. Category two provides for the patient to be seen by a doctor or appropriate person within 10 minutes. This is the most urgent category possible for a patient, including a psychiatric patient, unless he or she has in addition sustained life-threatening physical trauma, requiring, for example, immediate resuscitation.
There were two sources of evidence from Nurse Blake. The first was the hospital form which was partially completed by her and the second was her oral evidence. She did not make a written statement or, if she did, it was not put in evidence and we have not seen a copy. The contemporary notes show that Mr Takoushis was registered at 1302 and that he had been "attempting suicide". The time of triage was noted by Nurse Blake as 1311, although it could possibly be 1315. Against "flow chart" she wrote "mental illness", and specified the category as 2. Nurse Blake also recorded that Mr Takoushis was at "high risk of self harm".
Nurse Blake took Mr Takoushis' temperature at 1315 and his blood pressure and the like shortly thereafter. Her evidence was that she was with him until about 1330, when she wrote up the notes in which she summarised the position thus:
"Brought in by LAS. Summoned by Police. Patient seen standing on Tower Bridge intending to jump. Police involved with negotiation for 45 mins. O/A patient very calm, complained of slight frontal headache. Says he went to bridge to do "silly thing". Says has been having problem with his wife, who is accusing him of having affairs. Good eye contact. Limited English."
Nurse Blake then contacted the psychiatric liaison nurse ("the PLN") because at 1330 she noted: "PLN aware. Will need to be seen by A&E Drs first". The conclusion that the patient would have to be seen by a doctor before being seen by the PLN was in accordance with the protocol then in place. At about 1335 Nurse Blake handed over to a colleague, Staff Nurse Brown, and played no further part in Mr Takoushis' case.
There was no evidence from Nurse Brown but it...
To continue reading
Request your trial
-
The Queen (on the application of Maureen Speck) v HM Coroner for District of York NHS England and Another (Interested Parties)
...must have been spent on something else. He sought to rely on a passage at paragraphs 49–50 of the judgment of the court in R (Takoushis) v Inner North London Coroner [2006] 1 WLR 461 at p476 in which the court held that a coroner had reached a contentious conclusion before the inquest began......
-
Liam Grant v Roche Products (Ireland) Ltd and Others
...LIABILITY ACT 1961 S48(1) CORONERS ACT 1962 POWELL v UNITED KINGDOM 2000 30 EHRR CD 362 R (TAKOUSHIS) v INNER NORTH LONDON CORONER & ANOR 2006 1 WLR 461 EUROPEAN CONVENTION ON HUMAN RIGHTS & FUNDAMENTAL FREEDOMS ART 2 BARRY v BUCKLEY 1981 IR 306 SUN FAT CHAN v OSSEOUS LTD 1992 1 IR 425 K ......
-
Savage v South Essex Partnership NHS Foundation Trust
...of gross negligence can perhaps be seen by reference to two cases in this court, namely R (Takoushis) v Inner North London Coroner [2005] EWCA Civ 1440, [2006] 1 WLR 461 and R (Khan) v Secretary of State for Health [2003] EWCA Civ 1129, [2004] 1 WLR 971. They were both cases about the d......
-
Rabone and another v Pennine Care NHS Trust
...appears to have been accepted by the Court of Appeal in a short obiter passage at the end of the Judgment of the Court in R (Takoushis) v Inner North London Coroner [2005] EWCA Civ 1440, [2006] 1 WLR 461. [108] We add only this. We do not accept Mr Fitzgerald's submission that the principl......