Rabone and another v Pennine Care NHS Trust

JurisdictionEngland & Wales
JudgeMR JUSTICE SIMON,Mr Justice Simon
Judgment Date23 July 2009
Neutral Citation[2009] EWHC 1827 (QB)
Date23 July 2009
CourtQueen's Bench Division
Docket NumberCase No: 6MA 15087

[2009] EWHC 1827 (QB)




Manchester Civil Justice Centre

1 Bridge Street West, M3 3FX


Mr Justice Simon

Case No: 6MA 15087

Richard Rabone
(In His Own Right & as Personal Representative of the Estate of Melanie Rabone)
Gillian Rabone (In Her Own Right)
Pennine Care Nhs Trust

Mr R Francis QC and Mr N Poole (instructed by Pannone LLP) for the Claimants

Ms M Carss-Frisk QC and Ms J Mulcahy (instructed by Hempsons) for the Defendant

Hearing dates: 18–22 May 2009

Approved Judgment

I direct that pursuant to CPR PD 39A para 6.1 no official shorthand note shall be taken of this Judgment and that copies of this version as handed down may be treated as authentic.


Mr Justice Simon:



On 20 April 2005 the Claimants' daughter Melanie Rabone ('Melanie') committed suicide. She was aged 24. The previous day she had been allowed home leave from Stepping Hill Hospital ('the Hospital'). She had been admitted to the Hospital on 11 April, following suicide attempts, and had been treated for severe depression.


The First Claimant ('Mr Rabone') brought a claim on behalf of Melanie's estate which has been compromised. The Claimants bring the present claim under section 7 of the Human Rights Act 1998 (' HRA') on the grounds that the Defendant ('the Trust'), which was responsible for the management and control of the mental health services at the Hospital, acted in a way which was incompatible with its obligations under article 2 of the European Convention on Human Rights ('the Convention').

The facts up to the time of Melanie's death


The central facts in the case are not substantially in dispute.


Melanie first suffered the symptoms of depressive illness in 2000. After this, and despite intermittent episodes of anxiety, her condition improved. On 4 March 2005, she attempted to commit suicide by tying a pillow-case around her neck. On the same day she was admitted to the Hospital.


On 7 March 2005, while a patient on Warren Ward, she was assessed by Dr Joseph Meagher, a Consultant Psychiatrist, and Dr Diane Cook, a Senior House Officer. Dr Meagher diagnosed a severe episode of a recurrent depressive disorder. Warren Ward was part of the Mental Health Services Unit at the Hospital. At a ward round on 14 March Melanie was assessed as having shown sufficient signs of recovery to be allowed overnight leave. On 18 March, she was seen again by Dr Meagher and was discharged. A family holiday to Egypt had been booked; and the family spent a week away together.


While on holiday Melanie's mental state became increasingly frail; and this continued following the family's return to England. On 31 March, she cut her wrists with broken glass and was seen at A&E department at the Hospital. Dr Meagher advised she should be readmitted; however no beds were available at the time on Warren Ward.


On 6 April 2005 Melanie had an appointment with Dr Cook at the Hospital outpatient clinic. She was noted as having occasional thoughts of suicide, and frequent thoughts of deliberate self-harm.


On 11 April 2005, Melanie tied lamp flex around her neck. Her face became swollen and there were ligature marks around her neck. Her parents also found a hosepipe and tape hidden in her room. She was assessed by Dr Cook who noted on the medical notes:

Impression: Severe depressive episode … ?psychosis, High risk DSH (deliberate self harm) and suicide.


Melanie agreed to her informal admission to the Hospital; but Dr Cook noted that, if she attempted or demanded to leave, she should be assessed for detention under the Mental Health Act 1983. She was prescribed a course of drugs and thereafter kept under continuous 15 minute observation.


The Trust had a 75-page Care Programme Approach ('CPA') Policy dated January 2005. The CPA Policy focussed attention on the importance of using approved documentation as part of risk assessment and the management of risk in relation to mental health patients at paragraph 10.4.

There is a clear organisational expectation that practitioners consistently utilise approved risk assessment and management documents and processes. However there is also recognition that in keeping with the dynamic nature of risk, the documentation and processes will be kept under review.

Paragraph 10.10 provided that risk assessment,

… should be undertaken [at] … hospital admission, leave and discharge

It is part of the Claimants' case that there were deficiencies in implementing the CPA Policy in relation to Melanie's home leave on 19 April.


A full Mental State Examination was carried out on admission by one of the nurses on the ward, Nick Tatnall, as part of the CPA risk profile. He assessed Melanie as being a moderate to high suicide risk. He also filled out a Risk Profile document, which indicated that further assessment or information was required in the light of various indications of risk.


At 8 pm on 13 April Mr Rabone spoke to Nurse Tatnall. The Nursing notes record that Mr Rabone,

… expressed grave concern about Melanie's current condition and her not being sent out on leave or discharged too soon.

He was told that she would need to see a doctor before leaving Warren Ward.


There were further conversations during the course of the week between the Hospital staff and the Claimants, during which they expressed their concern about Melanie's impulsiveness and the risk of self harm.


On 16 April 2005, Nurse Tatnall recorded that Melanie 'appeared brighter in mood'. Later that day she was taken off the Warren Ward by Mr Rabone, but within the Hospital premises.


There is an issue about a note written by Melanie, which showed strong suicidal ideation. This was written on the back of a note containing some affectionate verses from her sister, Amanda. The timing of the note, and whether and (if so) when it was handed to the nursing staff by Mr Rabone are in issue.


There are notes in the nursing reports over the following days that Melanie's mood was lifting. However, at 1 pm on 18 April Mr Rabone was recorded as telephoning the Ward expressing concern that Melanie was not improving, that she had expressed fleeting suicidal thoughts since admission and had asked her parents to 'get her out' of the Hospital. 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. She expressed the wish to go out the next day with her parents, and was told that she could provided they agreed.


On 19 April 2005 Dr Meagher, who had been away when Melanie was admitted on 11 April, returned from leave. He was told that Melanie was requesting home leave. On the late afternoon ward round he met Melanie and her mother. Nurse Erin Booth was present at the ward round and made a record in the Nursing Notes.

Dr Meagher, Dr Davies, SN Erin Booth. Melanie seen with her mother. She states she self harmed at home due to feeling angry at herself because of the thoughts she has. Realises that does not achieve anything. Feels trapped at home 'slightly'. Would like to be more independent. Stated enjoyed recent trip to Egypt. Does not regret leaving employment. Wishes to look for something else. Does not want to stay in destructive cycle. Struggling to recognise how she can stop same. Feels she is lacking in confidence and has low self-esteem. Identified ways of addressing issues herself. Would like to leave for up to a week. Would start looking for job and see friends. Leave agreed as long as Melanie when seeing her friends does not talk about herself and become centre of attention. Reasons for this also discussed. Mother concerned about same as unable to keep eye on her. Dr Meagher advised Melanie has to take responsibility for own actions and when has previously harmed herself it has been when parents keeping an eye on her. Melanie in agreement that will not self-harm

Plan—for 2 days/nights leave


As had been recorded in the Nursing Notes, Mrs Rabone had expressed her concern about Melanie going on home leave at this time. Melanie, however, was keen to do so; and she and her mother left the Ward by 7.40pm for her 2 days home leave.


The Claimants are highly critical of both Dr Meagher's decision to allow Melanie home leave and the assessment of the risk which preceded it.


It is now common ground that Dr Meagher's decision was negligent. Both expert psychiatrists who have prepared reports in this case agree that Melanie should not have been allowed home leave at this time; and that, if she had insisted on leaving, she should have been assessed and, following such assessment, would have been likely to have been detained under the powers conferred by the Mental Health Act 1983.


Melanie spent most of the following day (20 April) with her mother; but in the late afternoon she said she was going to see a friend. At some time after 5 pm she hanged herself from a tree in Lyme Park.

The facts following Melanie's death


On 26 April the hospital received a request from HM Coroner for a statement from the medical and nursing staff having charge of Melanie's care.


On 31 August 2005, Mr Rabone wrote a letter of complaint to the Trust. The letter began

After much deliberation in what has been a difficult period for my family, I am writing to express our concerns regarding the treatment given and decisions made by members of your medical staff in the Mental Health Unit at Stepping Hill Hospital in relation to our daughter Melanie in March and April. We feel that the failure to successfully treat her clinical depression and the subsequent granting of home leave from a secure ward, directly contributed to her taking...

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3 cases
1 books & journal articles
  • Satisfying Claims? Money, Tort, and ‘Consumer Society’
    • United Kingdom
    • Social & Legal Studies No. 20-4, December 2011
    • 1 December 2011
    ...value of Melanie’s life; butwould, together with the other matters I have referred to, recognize the breaches of Conven-tion rights’ ([2009] EWHC 1827 (QB) [135]).22. Givenchanges in funding regimes,particularly the shiftfrom legal aid to conditional feesand per-haps in thefuture contingenc......

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