R v Dr James Donald Collins and Ashworth Hospital Authority ex parte Ian Stewart Brady
| Jurisdiction | England & Wales |
| Judgment Date | 10 March 2000 |
| Date | 10 March 2000 |
| Court | Queen's Bench Division (Administrative Court) |
Court and Reference:Administrative Court ; CO/68/2000
Maurice Kay J
B Hytner QC, P Kaufmann and R Makin (instructed by E Rex Makin & Co) for the Claimant; N Pleming QC and E Grey (instructed by Reid Minty) for the Defendants.
Whether the force-feeding of a detained personality disordered patient who expressed the wish to die was treatment under the Mental Health Act 1983.
B was sentenced to life imprisonment in 1966 for three murders; he has a whole life tariff, and accepts that he will never be released. In 1985, he was transferred to what became Ashworth Hospital, one of the special hospitals, under s. 47 Mental Health Act 1983. Additional restrictions are imposed on his movement within the hospital because of his notoriety. There were rumours in the media that B was to be returned to prison, a course of action which he feared. A decision was taken that he should be moved to a more secure ward in the hospital, which was effected by staff in riot gear, and involved B being strip searched. B had not been a management problem at the hospital; he did not resist, but his arm was broken in the move. B commenced a hunger strike, initially as a protest at the move. There was an external review of the move, which concluded that it was carried out in an inappropriate manner. The hunger strike continued, B now expressing the view that he wished to die as there was nothing for him to live for, as he accepted that he would die in custody. B's physical condition was monitored, and it was decided to commence force feeding by naso-gastric tube. The continuation of this process was challenged. The question was whether the feeding amounted to treatment for B's disorder, in which case it could be given without his consent.
1. The Applicant is 62 years old. On 6 May 1966 at Chester Assizes he was convicted of three murders and sentenced to three concurrent terms of life imprisonment. His offences, and those of his co-defendant, Myra Hindley, are often referred to as "the Moors Murders". The Secretary of State has fixed a full life tariff and the Applicant (unlike Miss Hindley) accepts that he will never be released. For many years he was detained in high security prisons but on 29 November 1985 he was transferred to Park Lane Hospital by a Transfer Direction which referred to his suffering from mental illness within the meaning of the Mental Health Act and stated that the mental disorder was of a nature or degree which made it appropriate for him to be detained in a hospital for medical treatment. Park Lane Hospital, together with the nearby Moss Side Hospital, was later reorganised to form Ashworth Hospital. From his admission in November 1985 until June 1995 he was detained in Newman Ward. On 16 June 1995 he was moved to Jade Ward within the former Moss Side site. The move was carried out with police assistance because it involved movement outside the perimeter wall and along a short stretch of public highway. The move was uneventful. Throughout this period the authorities were mindful of the position of the Applicant and they made arrangements which, in his own interests, limited his freedom within the Hospital. To compensate for or counterbalance this they afforded him additional facilities, in particular a personal computer and special visiting arrangements.
2. For a number of reasons unrelated to the Applicant, Ashworth Hospital attracted public criticism and on 7 February 1997 an Inquiry was set up under the chairmanship of His Honour Peter Fallon QC. The ensuing Report recommended that "Ashworth Hospital should close in its entirety at the earliest opportunity". However, the Secretary of State for Health did not accept this recommendation. Without descending into unnecessary detail, the outcome was a more restrictive regime, the consequences of which included the withdrawal of the Applicant's computer and an increase in the security arrangements for visitors. In addition, the Applicant began to fear a return to the prison system.
3. On 18 June 1999, a Mental Health Review Tribunal considered the Applicant's position as part of a routine review and not at the request of the Applicant. It concluded that:
"the patient remains mentally ill and subject to a psychopathic disorder. His persistent verbal abuse of staff is largely attributable to such conditions. The patient is appropriately hospitalised for his own health and the safety of himself and others."
4. At the same time the Tribunal expressed disappointment about the withdrawal of his computer and added that in its view:
"no step ought to be taken to reduce Mr Brady's quality of life unless such can be adequately justified in his particular case. The patient's unique position in Ashworth would seemingly justify an individual approach to such matters as access to computers, visits and the like."
5. Until at least early September 1999, the staff in Ashworth were content that the Applicant should remain on Jade Ward although for about a year they had considered alternatives. His Responsible Medical Officer (RMO) had been Dr Rajan but he was about to retire, whereupon Dr Collins would take over as RMO. As September wore on, there were newspaper articles referring to the Applicant as being suspected of a plan to escape from Ashworth and to a possible return of the Applicant to the prison system. There is no doubt that the media have taken an intense interest in the Applicant throughout his time in prison and in Ashworth. There is also no doubt that he has a profound fear of a return to prison. By 21 September Dr Diane James, the Acting Medical Director, who had been expressing concern about Jade Ward and the Applicant's continued presence on it, arranged a meeting for 30 September at which such issues would be reviewed. On 27 September a Patient Care Team Meeting noted "serious concerns" about security on Jade Ward. On 29 September, senior management and security staff discussed the possibility of moving the Applicant. Dr James caused Dr Rajan and Dr Collins to be contacted by telephone and they agreed that he should be moved as soon as possible to a more secure environment where his programme of care could be appropriately managed. Senior management decided to act quickly. The meeting that had been arranged for the next day was called off. No one told the Applicant that he was about to be moved.
6. In the late morning of 30 September the Applicant was writing in his room when a six-strong Control and Restraint team entered in full riot gear. Without offering any explanation they manhandled him, strip searched him and took him under restraint to a waiting van. Half an hour after their arrival in his room, the C and R team delivered the Applicant to Lawrence Ward where he remained under restraint until the team withdrew. The total period of restraint lasted for about fifty minutes. There is substantial consistency between the Applicant's account of these events and the accounts of those who carried out the move. It is common ground that the Applicant offered little, if any, resistance. According to him, he repeatedly complained that his right arm was hurting as a result of the restraint holds. Clearly that arm was injured in the move. A medical report by a consultant orthopaedic surgeon describes changes on x-ray suggestive of an undisplaced crack fracture at the distal end of the radius which would be likely to result in a full and permanent recovery "quite quickly".
7. Upon the Applicant's arrival on Lawrence Ward, there was a formal transfer of RMO responsibilities from Dr Rajan to Dr Collins. No one told the Applicant on 30 September why he had been transferred from Jade to Lawrence. In the course of the move he feared that he was being transferred to prison. At no time during his fifteen years in Ashworth (or the previous twenty years in prison) had the Applicant ever assaulted or offered physical resistance to staff.
8. The response of the Applicant to these events was an immediate refusal to take food or nutritionally sweetened drinks. From that day to this he has been on hunger strike. During October his health was monitored on a daily basis. It is clear from the medical records and not disputed by the Applicant that, in the early stages, his motive was to protest rather than to starve himself to death. He had deployed hunger strikes as a tactic in disputes with the prison authorities many years before. On this occasion, his repeatedly stated grievance related to "the move". He was very soon in contact with his solicitor who, on 25 October, wrote to the Mental Health Act Commission seeking an investigation and adding:
"Our client is still not eating. When the writer saw him on 14 October there was a distinct possibility that he would resume eating if an effective investigation was promptly commenced by the Commission"
9. By the end of October the clinicians were faced with changing circumstances. On 19 October Dr Collins had prepared a "draft of an argument that Mr Brady might warrant feeding against his will". Contact was made with Professor Krasner, a consultant general physician at a nearby hospital, for advice about the physical implications. On 21 October the Ashworth staff commenced daily blood pressure, pulse, temperature and respiration rates. The next day, Dr Rix, a consultant forensic psychiatrist based in Yorkshire, attended at Ashworth in order to provide Dr Collins with a second opinion but the Applicant refused to see him. On and after 25 October the Applicant refused blood tests and medication. Dr Collins devised a Short Term Plan on 27 October. He noted several forms of deterioration and added:
"It is my view that the care team should intervene, actively if necessary, to prevent this deterioration in Mr Brady's condition and prevent further worsening it seems to me that the immediate risks of not acting in the current...
To continue reading
Request your trial
- Broadmoor Special Hospital Authority and Another v Robinson
-
Ashworth Hospital Authority v MGN Ltd
... ... , the 'Investigations Editor', about Ian Brady, who, with Myra Hindley, was convicted in 1966 of ... 15 Dr James Collins, the Consultant Forensic Psychiatrist who ... 551 by Lord Keith; R v Home Secretary, ex parte Simms [1999] 3 WLR 328 at p.336 by Lord ... ...
-
Mersey Care NHS Trust v Ackroyd (No.2)
... ... for information he obtained about Ian Brady in November 1999. In particular what is sought is ... , Mersey Care NHS Trust, succeeded to Ashworth Hospital Authority on 1 st January 200In 1999 ... releases drafted in consultation with Dr Collins, the Chief Executive, Mr Clarke, the Medical ... including the delay in releasing Mr Stewart Brady's records notwithstanding the serious ... him copied on 14 April 2000 by Dr Diane James, the Medical Director, to a number of the ... ...
-
R (Mersey Care NHS Trust) v Mental Health Review Tribunal
...decision to feed him forcibly after he had started a hunger strike. In R v Collins & Ashworth Hospital Authority ex p Brady [2000] Mental Health Law Reports 17, [2000] Lloyds Medical Reports 355 Maurice Kay J, as he then was, held that Mr Brady lacked capacity in relation to all his decisio......
-
Table of Cases
...Authority ex parte K [2001] EWCA Civ 240 190 R v Chiles [2012] 1 MHLR 60 110 R v Dr Collins & Ashworth Hospital Authority ex parte Brady [2000] 1 MHLR 17 230 R v Drew [2003] UKHL 25 99, 178, 279 R v Fort [2013] EWCA Crim 2332 111, 127 R v Goucher [2012] 1 MHLR 107 110 R v Howell [1981] 3 WL......
-
Mental Capacity Act 2005 - Overview
...view to his mother on any subject that matters’, meant that he did not. In R v Dr Collins & Ashworth Hospital Authority ex parte Brady [2000] 1 MHLR 17, Ian Brady, on hunger strike, was found (applying a similar common law test) to lack capacity to make a decision regarding food refusal and......