Re B (A Minor) (Treatment and Secure Accommodation)
| Jurisdiction | England & Wales |
| Judgment Date | 1997 |
| Year | 1997 |
| Date | 1997 |
| Court | Family Division |
CAZALET, J
Medical treatment – whether court in exercise of inherent jurisdiction could permit use of reasonable force for purpose of imposing medical treatment – competency of minor to refuse to consent to treatment – whether order appropriate.
Secure accommodation – hospital ward with restricted access – whether ward could be regarded as secure accommodation – whether authorization for use of secure accommodation appropriate.
A girl aged 17 was the subject of a deemed care order arising from an earlier care and control order made in wardship proceedings in 1988. In 1992 the court had directed that the wardship should continue during the girl's minority thus bringing the deemed care order into being. The girl had a crack cocaine addiction. She had become pregnant but had received no antenatal care as she had phobias about doctors, needles and medical intervention generally. However, on 15 November 1996 she was persuaded to see a consultant obstetrician and gynaecologist at his antenatal clinic at a general hospital. She was then found to be 33 weeks into her pregnancy. She agreed to see the consultant again the following week. The next day she was admitted to another hospital suffering from eclamptic fits brought on by extremely high blood pressure. This condition carried a very high risk for both mother and child. When she arrived at the hospital she was very drowsy and the appropriate treatment was administered without any refusal from her. Later that day her waters broke giving rise to a serious risk of infection to the womb with potentially fatal consequences for her, the child, or both. As soon as she was fit enough to realize she was in hospital she sought to discharge herself and did so the following day, 17 November 1996. However, the next day, 18 November, a midwife was able to persuade the girl to be admitted to the maternity unit at the general hospital where she had seen the consultant. At first she refused to be examined. The consultant told her that if she continued to refuse medical assistance she would be placing both her own life and that of her child at a very high risk. Despite this she insisted that she wished to discharge herself. Later that day, on the application of the local authority with parental responsibility for the girl, the High Court made an ex parte order which, inter alia, provided that she should undergo such medical treatment as might in the opinion of the responsible doctor be necessary and that reasonable force could be used in the course of such treatment. The girl then accepted treatment and later that evening she gave birth to a daughter by Caesarian section. The consultant believed that her recovery period would be six to seven days during which time she would be closely monitored.
When the matter came before the court for an inter partes hearing the local authority applied for leave to place the girl in secure accommodation pursuant to an order under s 25 of the Children Act 1989. The local authority also sought the continuation of the ex parte order as to medical treatment made on 18 November. The girl was still in hospital and was currently agreeing to necessary treatment but if she later refused treatment her condition could deteriorate and a crisis situation could develop which could be fatal if she was not treated within 12 hours.
On behalf of the girl it was submitted that the hospital ward where she currently found herself could not be held to be secure accommodation within the meaning of s 25 of the 1989 Act so that the application for such an order was misconceived. It was further submitted that the order as to medical treatment should be amended to delete the provision that reasonable force could be used to administer necessary medical treatment.
Held – (1) As to medical treatment, the girl, as a minor who had attained the age of 16, had a right to consent to treatment: s 8 of the Family Law Act 1969. Thus, she had the right to refuse to give her consent to treatment. But this right to refuse consent did not override a consent to treatment by someone who had parental responsibility for her or a consent by the court. Nevertheless such a refusal was a very important consideration in making clinical judgments and for parents and the court in deciding whether themselves to give consent; and its importance increased with the age and maturity of the minor. However, on the facts in the present case the girl had been shown to lack the necessary mental competence to make treatment decisions in that she could not (a) comprehend and retain treatment information, (b) believe such information, and (c) weigh the information in the balance and make a choice. Therefore the requirement of her consent to necessary medical treatment in the face of a condition which was life-threatening or was a serious danger to her health carried very limited weight. Furthermore, her mother and the local authority both had parental responsibility for the girl and could take such steps as might be appropriate to protect the best interests of the girl; that could permit the use of reasonable force for the purpose of imposing intrusive necessary medical treatment on her where a life-threatening situation arose or where a serious deterioration in her health might occur if appropriate treatment was not administered. It would therefore be ordered that as the girl was competent neither to consent to nor to refuse medical treatment, such reasonable force might be authorized by the local authority to be used to implement such medical treatment to the girl as might be considered necessary by the doctors concerned for her to prevent her death or serious deterioration in her health.
(2) As to the application for a secure accommodation order, the girl was in a maternity ward to which entry and exist could only be effected by use of a key or pass and she was not provided with a key or pass. Having regard to the manner in which the girl was confined to this ward, with nursing staff instructed to prevent her leaving so that her life and health were not seriously endangered, the ward should be regarded as secure accommodation within the meaning of s 25 of the Children Act 1989. It was the restriction of liberty which was the essential factor in determining what was secure accommodation. To constitute secure accommodation a place did not have to be so designated; each case would turn on its own facts. On the facts of this case the girl was being held in accommodation provided for the purpose of restricting liberty. As it was conceded that if she was kept in any other accommodation she was likely to injure herself, this was a case where the court could give the local authority leave to retain the girl in the maternity ward as secure accommodation. In this case the girl had previously absconded regularly from various families and units where she had been placed. Further, she had made clear her resistance both to going to hospital and to staying there. In those circumstances the local authority were granted leave pursuant to s 25 of the 1989 Act to place and/or retain the girl in secure accommodation at the hospital for a period of seven days.
Statutory provisions referred to:Children Act 1989, ss 25 and 41.
Children (Secure Accommodation) (No 2) Regulations 1991, reg 2(1).
Family Law Reform Act 1969, s 8.
Local Authority Social Services Act 1970, s 7.
National Health Service and Community Care Act 1990, s 5.
Cases referred to in judgment:C (An Adult: Refusal of Treatment), Re[1994] 2 FCR 151; [1994] 1 WLR 290; [1994] 1 All ER 819.
R (A Minor) (Wardship: Consent to Medical Treatment), Re[1992] 2 FCR 229; [1992] Fam 11; [1991] 3 WLR 592; [1991] 4 All ER 177.
R v Northampton Juvenile Court ex parte London Borough of Hammersmith and Fulham [1985] FLR 193.
Tameside and Glossop Acute Services Trust v CH[1996] 1 FCR 753.
W (A Minor) (Medical Treatment: Court's Jurisdiction), Re[1992] 2 FCR 785; [1993] Fam 64; [1992] 3 WLR 758; [1992] 4 All ER 627.
Henry Setright for the local authority.
Gillian Irving for the minor.
Michael Nicholls, solicitor, as amicus curiae.
The minor's mother did not appear and was not represented.
MR JUSTICE CAZALET.This application concerns a minor, a girl who was born on 13 October 1979, so she is now 17 years and one month old. The parties to the proceedings are the local authority, who are the plaintiffs in the proceedings, Mrs K, who is the first defendant, and the minor, who is the second defendant. She is not as yet represented by a guardian ad litem in the proceedings but she is represented before me by counsel and solicitors.
The first defendant is the mother of the minor. She is neither present nor represented but I am told that she supports the local authority's application. On the night of 18/19 November 1996 the minor gave birth to a little girl. I am also told that an emergency protection order has been made in respect of the baby, her birth having taken place in a general hospital.
The minor was the subject-matter of an out of hours order made by me on the evening of Monday, 18 November 1996. It was consequent on that order, after medical advice had been obtained, that the minor was taken to hospital, where a Caesarean section was performed and the baby was born. I was given...
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Re C (Detention for Medical Treatment)
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