Riverside Mental Health NHS Trust v Fox

JurisdictionEngland & Wales
JudgeTHE PRESIDENT,LORD JUSTICE LEGGATT,ORDER
Judgment Date28 October 1993
Judgment citation (vLex)[1993] EWCA Civ J1025-3
CourtCourt of Appeal (Civil Division)
Date28 October 1993

[1993] EWCA Civ J1025-3

IN THE SUPREME COURT OF JUDICATURE

COURT OF APPEAL (CIVIL DIVISION)

ON APPEAL FROM THE HIGH COURT OF JUSTICE

FAMILY DIVISION

(Order of Mr. Justice Wall)

before: The President Lord Justice Leggatt Lord Justice Kennedy

Carolyn Fox
Appellant
and
Riverside Health Trust
Respondent

Mr. R. GORDON (instructed by Fisher Meredith, London SW4 6TA) appeared on behalf of the Appellant

MR. S REEDHEAD (instructed by Radcliffes, London SW1P 3SJ) appeared on behalf of the Respondent

1

( )

2

Monday 25th October 1993

THE PRESIDENT
3

THE PRESIDENTThe court has before it an appeal by Carolyn Fox, who is a patient at the Riverside Mental Health Trust, against the judgment of Wall J of 22nd October last, when he refused to set aside an order made by Stuart-White J at an ex parte hearing on 20th October 1993.

4

The proceedings, which came originally before Stuart-White J upon an ex parte application, reflect the sensitive and difficult nature of the responsibilities of members of the medical profession. The patient is suffering from the condition known as anorexia nervosa. She has suffered previous episodes of that disorder. The doctor in charge of her treatment, Dr. Robinson, a consultant at the Gordon Hospital, was desperately anxious about the condition of his patient. On 20th October 1993, he gave evidence at what was an ex parte hearing before the Applications Judge, Stuart-White J, in the Family Division, in support of an application by the Hospital Trust for a declaration that compulsory feeding (sometimes described as force feeding) of the patient would be lawful in the then existing circumstances. The doctor's evidence was to the effect that this unfortunate lady had reached a stage when her weight loss was extreme. In his judgment this meant that if she lost more weight, it could lead to fatal complications. In his evidence to the learned judge, he said:

5

"I regard the matter as grave and urgent."

6

The patient was being treated under the provisions of the Mental Health Act 1983. The doctor said that in his view the condition of anorexia nervosa in this patient's case required that she should be fed. That was an essential part of her treatment at that stage, but it was an essential part of the treatment in respect of the condition of anorexia nervosa, which was, in his judgment, a mental disorder. The application was, as I have said, made ex parte.

7

It appears that the patient had consulted, but she did not have legal aid, and although notice was given to the solicitors by the Riverside Trust that the application was to be made, they did not feel able to appear at the ex parte hearing. Accordingly, the learned judge did not have the advantage of argument about the substance of the application. He was only able to deal with it, as he said in his short judgment, upon the basis of Dr. Robinson's evidence and the brief submissions of counsel for the Riverside Trust.

8

The learned judge in his short judgment said at page 42 of the agreed bundle before this court:

"I am not able to make the Order sought unless I am satisfied that force feeding of the Respondent is medical treatment for her mental disorder under section 63 of the Mental Health Act. I have no difficulty at all in concluding albeit it without argument from the respondent that feeding is treatment within section 145 of the Mental Health Act. It is an essential part of nursing and care.

"It is more difficult to decide whether it constitutes medical treatment for the mental disorder. That disorder is anorexia nervosa. I have only heard evidence on one side but the evidence I have heard of Dr. Robinson is clearly to the effect that feeding a person suffering from anorexia nervosa is an essential part of that treatment and at the stage that the Respondent has got to, it is the essential part of the treatment.

"Until there is a steady weight gain no other treatment can be offered for the Respondent's mental condition so I hold that forced feeding if needed will be medical treatment for the mental disorder.

"It is impossible to say if the Respondent will co-operate with the stages of this that might be needed and it is not sensible to try to differentiate between these. I hope no restraint is needed but if the Respondent is unwilling the medical staff may need to go on to the other stages set out in the Originating Summons.

Accordingly I grant the relief sought in the Originating Summons."

9

He then made the declarations in the form of the Originating Summons. The terms of the Order appear at page 45 of the bundle before the court:

"(1) Forced feeding of the Respondent is medical treatment for her mental disorder under the provisions of section 63 of the Mental Health Act 1983;

(2) Further or alternatively, that spoon feeding the Respondent by a nurse without restraint is lawful.

(3) Further or alternatively, that spoon feeding by a nurse with another female nurse restraining the patient is lawful.

(4) Further or alternatively, if the Respondent refuses to accept food by spoon feeding or insufficient food to improve her weight and BMI level that it is lawful to sedate her and feed her by naso-gastric tube under the direction of appropriately qualified medical staff."

10

The order provided there should be no order for costs, and in paragraph (6):

"All parties are required to attend before the Judge in Chambers at the Central Office, Royal Courts of Justice, Strand, London WC2A 2LL on Monday the 25th day of October 1993 at 10.30am in the forenoon (time estimate one hour)."

11

That paragraph was included in the order because in his judgment, after saying, "Accordingly I grant the relief sought in the Originating Summons", the judge continued:

"This matter should be heard inter-partes on notice at the earliest opportunity. This should be before Monday 25th October 1993 because of the need for the Plaintiff to get legal aid and the non-availability of Dr. Robinson before that time".

I think the word "not" has been omitted. It should read: "not be before Monday 25th October 1993 because of the need for the Plaintiff to get legal aid and the non-availability of Dr Robinson before...

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12 cases
  • R v R (Interim declaration: Adult's Residence
    • United Kingdom
    • Family Division
    • Invalid date
    ...Case referred to in judgmentF v Riverside Mental Health NHS Trust[1994] 2 FCR 577; sub nom Riverside Mental Health NHS Trust v Fox [1994] 1 FLR 614, Fam D and CA. Ann Chavasse (instructed by Brendan Fleming) for the Hilary Watson (instructed by Bridge McFarland) for the defendant. David Her......
  • NHS Trust v T (adult patient: refusal of medical treatment)
    • United Kingdom
    • Family Division
    • 28 May 2004
    ...790) a contradiction in terms. That was recognised by this court, in the context of authority for medical intervention, in Riverside Mental Health Trust v Fox [1994] 1 FLR 614." 34 In the Riverside case referred to in that passage the declaratory order had been made ex parte and authorised......
  • Tameside and Glossop Acute Services Trust v CH
    • United Kingdom
    • Family Division
    • Invalid date
    ... WALL, J ... Medical treatment – adult patient detained under s 3 of the Mental Health Act 1983 – tests at 38th week of pregnancy showing development of foetus required ... F v Riverside Mental Health NHS Trust [1994] 2 FCR 577 ... F (In Utero), Re [1988] FCR 529; [1988] Fam 122; ... ...
  • St George's Healthcare NHS Trust v S; R v Collins and Others, ex parte S
    • United Kingdom
    • Court of Appeal (Civil Division)
    • Invalid date
    ...2 All ER 545, [1989] 2 WLR 1025, HL; affg [1990] 2 AC 1, [1989] 2 WLR 1025, CA. F v Riverside Mental Health NHS Trust[1994] 2 FCR 577, [1994] 1 FLR 614, Imperial Tobacco Ltd v A-G [1981] AC 718, [1980] 1 All ER 866, [1980] 2 WLR 466, HL. International General Electric Co of New York Ltd v C......
  • Request a trial to view additional results

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