R v Quick
| Jurisdiction | England & Wales |
| Judge | LORD JUSTICE LAWTON,To |
| Judgment Date | 18 April 1973 |
| Judgment citation (vLex) | [1973] EWCA Crim J0418-3 |
| Docket Number | No. 2384/B/72 |
| Court | Court of Appeal (Criminal Division) |
| Date | 18 April 1973 |
[1973] EWCA Crim J0418-3
IN THE COURT OF APPEAL
CRIMINAL DIVISION
Royal Courts of Justice
Lord Justice Lawton
Mr. Justice Mocatta
and
Mr. Justice Milmo
No. 2384/B/72
No. 2397/B/72
MR. J. A. COX appeared on behalf of the Appellant Quick.
MR. P. CLARKE appeared on behalf of the Appellant Paddison.
SIR JOSEPH MOLONY, Q.C. and MR. L. READ appeared on behalf of the Crown.
On the 19th April, 1972, at the Bristol Crown Court during a trial before Mr. Justice Bridge and a jury, the Appellant pleaded guilty to Count 2 of an indictment which charged him with assault occasioning actual bodily harm. This plea was tendered after a ruling by the trial Judge. That ruling is the subject of the appeal in this case as far as Quick is concerned. The trial went on against the Appellant Paddison. He was convicted of a similar offence in Count 1 of the indictment. Quick was sentenced to nine months' imprison ment, Paddison to six months.
Both now appeal against conviction by leave of the single Judge.
In its broadest aspects these appeals raise the question as to what is meant by the phrase "a defect of reason, from disease of the mind" within the meaning of the M'Naughten Rules. More particularly the question is whether a person who commits a criminal act whilst under the effects of hypogly-caemia can raise a defence of automatism, as the Appellants submitted was possible, or whether such a person must rely on a defence of insanity if he wishes to relieve himself of res ponsibility for his acts, as Mr. Justice Bridge ruled.
The Appellants were both employed at Farleigh Mental Hospital, Flax Bourton, Somerset. Quick was a charge nurse, Paddis on a State Enrolled nurse. At the trial it was not dis puted that at about 4.00 p.m. on 27th December, 1971, one Green, a paraplegic spastic patient, unable to walk, was sitting in Rosemount Ward at the hospital, watching television. Quick was on duty; Paddison had gone off duty at 2.00 p.m. but was still present in the ward. Half an hour later, Green had sus tained two black eyes, a fractured nose, a split lip which required three stitches, and bruising of his arm and shoulders. There was undisputed medical evidence that these injuries could not have been self-inflicted.
The Prosecution's case was that Quick had inflicted the injuries on Green and that Paddison had been present aiding and abetting him, not by actual physical participation, but by encouragement. On arraignment Quick pleaded not guilty. At the close of the evidence, following a ruling by the Judge as to the effect in law of the evidence relied upon by Quick to support a defence of automatism, he pleaded guilty to Count 2 of the indictment. The Judge's ruling was to the effect that this evidence could only be relied upon to support a defence of insanity.
The evidence upon which the Judge ruled came partly from witnesses for the prosecution and partly from Quick's own evidence and that of a consultant physician, Dr. Cates, who was called on his behalf. The evidence from the prosecution's witnesses included that of one Willerton, a State Enrolled nurse who was on duty in Rosemount ward at the material time. He said that at about 4.00 p.m. he had been summoned to the television lounge where he found Green on the floor with injuries to his face and struggling. Quick was sitting astride him. Quick seemed glassy eyed and made no reply when asked what he had done. A patient, one Clothier, in the course of his evidence, spoke of Quick having collapsed on the floor shortly after he had been involved in the assault on Green. In the course of his own evidence Quick said that he could not remember assaulting Green. He admitted that he had been drinking and that his drinks had included whisky and a quarter of a bottle of rum. He also said that he was, and had been since the age of seven, a diabetic and that that morning he had taken insulin as prescribed by his doctor. After taking the insulin he had had a very small breakfast and no lunch. Dr. Cates said that on twelve or more occasions Quick had been admitted to hospital either unconscious or semi-conscious due to hypoglycaemia, which is a condition brought about when there is more insulin in the bloodstream than the amount of sugar there can cope with. When this imbalance occurs, the insulin has much the same effect as an excess of alcohol in the human body. At the onset of the imbalance the higher functions of the mind are affected. As the effects of the imbalance become more marked, more and more mental functions are upset; and unless an antidote is given (and a lump of sugar is an effective one) the sufferer can relapse into coma. In the later stages of mental impairment a sufferer may become aggressive and violent without being able to control himself or without knowing at the time what he was doing or having any recollection afterwards of what he had done. The following answer by Dr. Cates sums up his evidence about hypoglycaemia and his opinion as to whether Quick could have been doing what he was proved to have been doing in the course of a suggested hypoglycaemic reaction:
"If a patient is going unconscious with a falling blood sugar, for a while he will be aggressive, for a while he will be more than aggressive, for a while he may start being physically violent and then he will be in a semi conscious state when he could be struggling and resisting people's efforts to give him sugar. Then he may have a fit, then he may stay deeply unconscious for quite a while. It would sound from the evidence …. that this man developed an increasing effect of a falling blood sugar from some time in the afternoon till when he collapsed after the episode of attack. At least the events fit with that."
Dr. Cates said that on three or four occasions whilst in hospital under treatment for diabetes Quick had behaved violently when his blood sugar had got too low.
As is well known insulin is prescribed by doctors in order to ensure that only the requisite amount of sugar is in the patient's blood-stream; but from time to time the sugar level may get too low. Dr. Cates said that there were a number of causes for this. The doctor may have prescribed too much insulin; the patient may have eaten too little or have been over active. He accepted that on the occasion when Green was attacked, Quick's own conduct that day may well have caused a severe fall in blood sugar.
At the trial and before this Court it was accepted by the prosecution that the evidence to which we have referred was enough to justify an is sue being left to the jury as to whether Quick could be held responsible for what he had done to Green. If the jury were to accept the evidence relied on by Quick what should the verdict be? Quick's counsel submitted "not guilty"; Sir Joseph Molony on behalf of the Crown submitted that it should be "not guilty by reason of insanity". The Judge ruled in favour of the Crown. As Quick did not want to put forward a defence of insanity, after consulting with his counsel, he pleaded guilty to Count 2.
As this plea had been made as a result of the Judge's ruling it was accepted by the Prosecution before this Court that if that ruling was adjudged to be wrong it would not be a bar to an appeal by Quick against his conviction.
After Quick had pleaded guilty, the trial went on against Paddison. The case against him was that he had aided and abetted Quick to assault Green by ordering the other patients out of the ward shortly before Quick started to act violently and by staying in the ward whilst Quick was doing so without making any attempt by word or act to stop him. It was admitted, however, that before the assault ended Paddison had left the room. His explanation for ordering the patients out of the ward was that Green had started to shout, which tended to upset the other patients, so he decided to get them out of the way.
The Judge summed up the case against Paddison on the basis that as Quick had pleaded guilty to assaulting Green there was no issue to be tried as to whether there had been an assault and that the only question was whether Paddison had aided and abetted Quick. The jury decided that he had and found him guilty on Count 1 which charged him jointly with Quick. Quick, however, had pleaded guilty only to Count 2. Before the decision of the House of Lords in D.P.P. v. Merriman, (1972) 2 All England Reports, 42, the verdict against Paddison on Count 1 might have caused difficulties; but we are satis fied that as a result of that case the verdict can stand in law despite the fact that no verdict against Quick was taken on it. The submissions made on Paddison's behalf were these: first, that the evidence did not justify a verdict of aiding and abetting; secondly, that by reason of the course the trial took, Paddison was deprived of an opportunity of submitting that he could not in law be guilty of aiding and abetting someone who was either insane or acting as an automaton; and lastly, if Quick's conviction was quashed, in all the circum stances of the case, the verdict of the jury against Paddison was unsatisfactory.
The question which the Judge's ruling raises is one upon which it seems that there is no direct English or Commonwealth authority and only a few which bear indirectly upon it. We are grateful to counsel for the depth of their researches.
Our examination of such authorities as there are must start with Bratty v. A. G. for Northern Ireland, (1963) A.C., 386, because the Judge ruled as he did in reliance on that case. Bratty had been accused of the murder of a young girl. He put forward three defences; first, that at the material time he was in a...
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