“Suspect has assaulted his father and sister, punching his father in the jaw and sister in her left eye. Suspect has then further assaulted an officer whilst resisting arrest, pulling at his arms causing red marks.”
“** APPROPRIATE ADULT REQUIRED** I have spoken with the OIC regarding the DP and there has been a delay in completing this entry due to custody demand. The victim of this matter are VERY concerned for the DP’s mental health. They have detailed that the DP has severe mental health issues and will require at the least an AA but family have requested a MH professional see the DP. They are concerned as his MH has deteriorated rapidly where the DP has been staring into to a mirror on his own for ages and ‘growling’ at the mirror. DP has previous for trying to kill himself by throwing himself off a bridge. This has not been disclosed by the DP upon being booked in and as such was assessed as not needing an AA. As such all bio-metrics and legal rights were taken without a AA at the time. Having this new information, failure to act on this could mean a prejudicial outcome for the DP. The matters in which the DP has been arrested are of a serious nature. With this encompassed with the new information I have – I believe as per the below the DP DOES require an APPROPRIATE ADULT. I RECOGNISE MY REQUIREMENT UNDER PACE CODE C1.13D TO ASCERTAIN WHETHER THIS DETAINEE ID VULNERABLE … I HAVE REASON TO SUSPECT THAT THIS DETAINEE IS VULNERABLE AS DEFINED ABOVE. The DP although he presents calm, coherent and lucid, the information provided to me is that he suffers badly with MH and this will interfere with the investigation and as such an AA will be needed.”
“Referred to CJLDS by Medway Police custody having been arrested for alleged assault of a family member. Prior to being seen RIO notes consulted. Tyler is not currently open to mental health services. He was detained under section 136 in January 2019 … … Seen in cell. Tyler, on hearing my introduction, immediately told me to ‘fuck off’. I enquired if there was anything at all that I could do to assist him to which he replied ‘No Chris, fuck off. Unless you can get me out of here’. I advised we could talk about what was happening to him and whether he required support on release but he again told me to ‘fuck off’, this time fixing me with a stare, raising his voice and pointing to the door. I immediately acted on his request and left the cell, closing the door behind me. While agitation/aggression have been indicative precursors to deterioration in his mental state previously there have also been many other factors involved, none of which I have been able to explore. I am unable to speak with his mother or write to his GP without his consent, which he is clearly not going to give to me. I have left a copy of the CJLDS leaflet with his property to be given on release from custody. I am informed that mother is aware of his arrest and will act as an AA. It seems she is well versed in his difficulties and she has acted in his best interests before. There is no significant risk to self-reported historically, save for the incident that led to his being detained under section 136 but this appears to have been an isolated incident.”
“There is no further role for CJLDS at this time.”
“Repeat effort made to assess. DP continues to decline my offer of assessment. DP also declined consent to me to speak with his mother”
“Received a call from Tyler’s dad (Marcus) stating that they visited their son at the hotel where they placed him after he was arrested for assault on family members. Marcus stated that they called the police after Tyler assaulted his sister. According to Marcus, he feels that Tyler would be worse on his own as he seems to be having mental health issues. Marcus was given SPOA contact details. Marcus would like to bring Tyler home but he is worried that he might fight his sister again. Marcus was advised to call the police if Tyler becomes aggressive. Plan: Marcus to contact SPOA. Marcus to contact [general practitioner].”
“Phone call from Marcus Lukes father (sic). He expressed concerns for Tyler’s mental health. He was worried about making the referral as he did not want Tyler to know that he had made the referral as Tyler will believe that family are ganging up against him. Advised that Tyler has seen CJLDs in last few days and that our clinicians are very tactful when calling someone who is referred. If Tyler is aware that family have called SPOA it would seriously affect the family relationship considerably. Marcus initially asked for services to support Tyler when he gets eventually home. Tyler has been aggressive to his father and sister so Marcus wants to ensure that his daughter is settled elsewhere before Tyler comes home. Marcus explained that when Tyler was 19 years old he took a lot of steroids along with drugs before EIS input. Marcus believes that Tyler does not take drugs now or drink alcohol but is completely withdrawn. He has isolated himself staying in his car. Marcus has now paid for Tyler to stay in a hotel. He is not eating properly. Paranoid about banks, he will not pay a cheque in as he is suspicious. He is talking to himself. Laughs to himself. He was beaten up badly just before his hospital admission. Marcus has concerns for the safety of Tyler as he is unpredictable.”
“Referred by his Father (Do not disclose referrer to Tyler) FIRST ATTEMPT to make contact and the call rang and was answered by Tyler, he said he was absolutely fine and did not want any support with his mental health. He asked that no more calls be made to his number. Declined triage. Discharged from SPOA.”
“Has now called ambulance – having psychotic episode – noted father had tried to contact SPOA on 15th – ambulance on way. Priority = 6.”
“The family are a high risk MARAC [Multi-Agency Risk Assessment Conference] family …. Object due family members being assaulted by Tyler Lukes who has a history of mental health… Son is kicking off - he could be heard screaming and shouting in the background.. mum has locked herself in the bathroom because of this - for safety reasons. Tyler appears to be suffering with a MH episode. the father is in the property trying to calm Tyler down … The mother said he is trying to run out the property. Not got any weapons as far as they know.”
“Patient has been upset and angry today according to parents shouting and proclaiming to be God, patient took a hammer and knocked on the neighbour’s door apparently to do some building work? Patient has been making cocktail bombs in a bottle? As he believes there are enemies after him. Patient believes anyone wearing red is the devil. Patient was sectioned one year ago and was released without medication? Patient’s mother and father are scared to be left alone with patient as they feel they will be killed in their sleep by patient. Psychiatric Harm: No Harm. Behavioural: Patient acting calm, appeared intelligent in the way he spoke, acting as if nothing is wrong, although from the things patient was saying became quite apparent there is mental health issues and patient possibly psychotic. Patient has extremist views and could quite easily be radicalised and is vulnerable to this therefore crew have completed an online form for reporting radicalization report number 80H- 1719- 20-0100- 000. Patient does not state to be suicidal although parents state patient was suicidal last week? Patient is no harm to himself. Psychiatric/Mental health notes Patient stating to be god and can heal himself, believes the police cannot enforce fake rules and people should not be forced to work. Patient appears to have some sort of mental health issues however has capacity and does not want any help or to attend A&E Secondary survey notes Spoke to patient GP which was on duty DR who stated patient has been contacted by the CRISIS team on 15 August and another service not long before that however both times patient has stated they do not want any help. GP advised for patient to contact CRISIS team as the GP surgery will not send a DR out for home visits and patient refused to go to surgery to see a DR. Police attended scene and believe patients extremist views and behaviour could stem from a previous incident where patient was beaten and attacked in public … … Patients parents state the mental health issue has been on going now for nearly 2 years. Patient was not aggressive on scene police unable to act on anything as patient did not need sectioning and had not committed a crime … Non-conveyed. Reason The patient requires assistance only / medical attention which has been provided by Ambulance staff.”
“Third party encounter spoke to paramedic Rose at scene - patient was aggressive and went with hammer to neighbour- police callled (sic) but as no action as he wasa (sic) calm they did not arrest and not for section he was last secxtioned (sic) in nov-no rx parents thing (sic) he is being radicalised and claiming about God etc. Advised paramedic best for admission to A&E to see dutty(sic) psychiatrisyt (sic) but patient refusing - he can also contact crisis team.”
“Have been able to speak to dad, who is concerned that Tyler has not been behaving. No offences, this has just been a MH ep, refused to ans dara. Tyler is currently with paramedics, and dad has stated that he seems to be responding well. Going to stay on scene, to ensure AIO. XTL noted and aware patrol state 6 not actively monitoring. This is not a domestic, further clarification from mother and father is that Tyler is suffering from mental health. They called SECAMB for assistance for this. There has been no argument which was confirmed by all parties in the property, as such no offences, no domestic has taken place. Paramedics spoke to Tyler who stated that he did not want or need medical attention, however permitted the paramedics to liaise with his doctor in relation to mental health concern. Paramedics confirmed that Tyler has capacity so are limited in what they can do. Officers spoke to Tyler and requested his permission to place an AP referral on him to help him engage with services, however Tyler refused. Tyler did make comments to police and SECAMB stating somewhat extreme views, regarding how the world is run and human should not be labelled as numbers. Officers on scene liaised with paramedics who confirmed that some form of mental health is taking place here, however if Tyler has capacity, they are limited in what they can do if Tyler refuses help, same as police. Officers have confirmed that all that can be done is place an intel report on in relation to what Tyler has stated, and paramedics have confirmed they will log this incident via one of their channels.”
“Parents contacted the ambulance service as they are concerned regarding his mental health. They said Tyler has not been sleeping and does not want to leave the house. His mum describes Tyler’s behaviour as erratic and said she is scared of him. Tyler is willing to engage with mental health services.”
“… his mother answered the phone and I explained who I was and she then tried to get Tyler to answer the phone. After about 10 minutes of me hearing his mother and father encouraging Tyler to answer the phone he came to the phone. Tyler informed me that he didn't want anything to do with the assessment. I explained to Tyler that people are concerned about him and he informed me ‘all I want to do is sleep’. Tyler then reported that when he walks down the street and he stops members of the public why are people rude to him. Tyler continued to state that he then keeps all is angry inside until he is home. Tyler did state that this is making him feel sad but he also reported that he has no thoughts of self harm or suicidal ideation. I then asked him what he did once home with the angry and he refused to disclose. I enquired if Tyler was currently taking any medication to which he reported he is not. I again asked Tyler if he would take part in the assessment to which he declined and became angry towards me. … Tyler is a 20 year old gentlemen who has a diagnosis of drug induced psychosis and looking at the notes Tyler is currently relapsing and will require a face to face duty appointment by the local CMHT (DGS). Tyler has refused to engage with this assessment due to his deteriorating mental health state. Urgent referral. The plan: 1) Tyler is discharged from SPoA caseload and transferred to the local Cmht (DGS) for an urgent assessment due to reported deteriorate mental health state. 2) Tyler has a diagnosis of drug induced psychosis. 3) Tyler will require a face to face assessment and due to his hx of non-engagement he will require a home visit so that the assessment can take place. 4) Tyler is currently on no medication.”
“…Pt fell/jump from a bridge (>25ft) and landed (feet first) on the railway tracks. Pt has not moved since the fall … ”
“37. On the balance of probabilities, had the First Defendant through Mr Parish carried out an appropriate and responsible assessment on12th August 2020 , he would or should have determined that the Claimant required an immediate psychiatric assessment by the CRHT that day who in turn would have involved the Approved Mental Health Professional Service (‘AMHPS’). In circumstances where the Claimant revealed florid thought disorder such as believing he was Jesus and presented significant risk to himself and his family, he would and should have been kept in custody until he was assessed by AMPHS. Upon assessment, he would have been admitted to hospital either as a voluntary patient or in the event of refusal, as a detained patient under Section 2 of the Mental Health Act. He would have been commenced on antipsychotic medication and kept under close review and assessment. The subsequent deterioration leading to his episode of self-harm on19th August 2020 would have been avoided. He would have made a reasonable recovery with relative stability, but would have been at risk of further relapses in the future. … 39. A similar management process and outcome would have followed to that above had the Claimant’s undergone an appropriate assessment on15th August 2020 . The Claimant would and should have been directly referred to AMHPS by Ms Hatful or to the CRHT. Upon same day assessment, he would have been admitted to hospital either as a voluntary patient or in the event of refusal, as a detained patient under Section 2 of the Mental Health Act. The outcome and long-term prognosis would have been the same as above.”
“(iv) each of the clinicians, nursing and/or police staff employed by the Defendants owed the Claimant a duty of care in respect of the treatment, care or services provided by them and the Defendants are vicariously liable for any breach of duty by them.”
“38. A similar management process and outcome would have followed to that above had the Second Defendant ensure that the Claimant underwent an appropriate assessment by a Healthcare Professional on12th August 2020 as it should have done.”
“Consideration was given whether there was underlying personality traits especially in context of past history. However, at present there is limited evidence of said traits impacting upon his health care needs. He is warm and engaging and is working well with the treating team at present. At present there is not acute thoughts of harm to self or others at present. Consideration was given whether this was a primary psychotic disorder. However, the rapid resolution of his symptoms without psychotropic treatment makes it less likely. Working diagnosis at present is either 1. Acute stress reaction in the context of recent break up 2. Unspecified mental and behavioural disorder secondary to psychoactive substances …”
“… in an impulsive [act] immediately following a phone call with his partner where she had ended the relationship. His previous episode of suicidality was precipitated by similar breakdowns in relationships.”
“There was no evidence of any mood disorder or any formal thought disorder. He was not observed to be responding to any abnormal stimuli. He was orientated to time, place and person. Tyler demonstrated insight into the event and capacity for decision making. Plan 1. No evidence of any mood disorder/psychosis at present, therefore psychotropic medication is not currently indicated. 2. No current need for DOL/Section 5(2) at present, no evidence of acute mental disorder. Ongoing liaison review to monitor mood and mental state. 4. Awaiting bed at Stoke Mandeville. 5. Update risk assessment ...”
“9.5 The custody officer must make sure a detainee receives appropriate clinical attention as soon as reasonably practicable if the person: (a) appears to be suffering from physical illness; or (b) is injured; or (c) appears to be suffering from a mental disorder; or (d) appears to need clinical attention. 9.5A This applies even if the detainee makes no request for clinical attention and whether or not they have already received clinical attention elsewhere. If the need for attention appears urgent, e.g. when indicated as in Annex H, the nearest available healthcare professional or an ambulance must be called immediately. … 9.8 If a detainee requests a clinical examination, an appropriate healthcare professional must be called as soon as practicable to assess the detainee's clinical needs. If a safe and appropriate care plan cannot be provided, the appropriate healthcare professional’s advice must be sought. The detainee may also be examined by a medical practitioner of their choice at their expense.”
“9A A ‘healthcare professional’ means a clinically qualified person working within the scope of practice as determined by their relevant statutory regulatory body. Whether a healthcare professional is ‘appropriate’ depends on the circumstances of the duties they carry out at the time..”
“5. The custody officer must make sure a person receives appropriate clinical attention as soon as reasonably practicable if the person appears to be suffering from a mental disorder or in urgent cases immediately call the nearest appropriate healthcare professional or an ambulance. See Code C paragraphs 3.16, 9.5 and 9.6 which apply when a person is detained under theMental Health Act 1983 , sections 135 and 136, as amended by thePolicing and Crime Act 2017 .”
“4. It is essential healthcare professionals who are consulted consider the functional ability of the detainee rather than simply relying on a medical diagnosis, e.g. it is possible for a person with severe mental illness to be fit for interview.”
“Condition of the detainee Officers should seek advice from an appropriate HCP [healthcare professional] if they have concern that a detainee has an injury, medical condition or a mental illness, appears to be experiencing mental ill health or otherwise requires medical attention. This does not apply to minor injuries or ailments, but officers should still note those in the custody record. If unsure of the nature of a condition, officers should call an HCP. See PACE Code C paragraph 9.5 and Notes for Guidance, Note 9C. … Custody officers need to be aware of the enhanced risk of suicide and self-harm during periods ofdetention. Detainees who are deemed to be a high risk of suicide or self-harm must be seen by an HCP and kept under close proximity supervision. This allows officers and staff to engage with the detainee and intervene if required … ”
“2.8.3 Exclusion criteria The following functions will not be pursued as part of the L&D service: - removal and detention of an individual in accordance withsection 136 of the Mental Health Act 1983 - street triage services - fitness to detain, fitness to interview and pre-release risk assessments - mental Health Act assessments - custodial in-reach services or post release services. However, it will be important for providers of L&D services to build interfaces with providers of the above functions. This service will also address the sharing of relevant flows of information with those providers, to ensure that any relevant diagnoses are made known for the purposes of access to appropriate health and social care services.”
“… those were the contacts upon which he seeks to assert his claim against D1 … in circumstances where he has capacity, and plainly refused any kind of assistance, it is difficult to see how or why D1 and their employees should be landed with any finding of liability.”
“21. The authorities therefore make clear that in the context of summary judgment the court is by no means barred from evaluating the evidence, and concluding that on the evidence there is no real (as opposed to fanciful) prospect of success. It will of course be cautious in doing so. It will bear in mind the clarity of the evidence available and the potential for other evidence to be available at trial which is likely to bear on the issues. It will avoid conducting a mini-trial. But there will be cases where the Court will be entitled to draw a line and say that - even bearing well in mind all of those points - it would be contrary to principle for a case to proceed to trial. 22. So, when faced with a summary judgment application it is not enough to say, with Mr Micawber, that ‘something may turn up’.”
“13. In seeking to overturn the judge's decision Mr. Pollock Q.C. for Allianz has drawn our attention to some of the many cases in which this court and others have warned against the dangers of disposing summarily of arguments that appear at first sight to be implausible or depend on establishing facts which, at the time of the application, seem very unlikely to have occurred. These warnings must be taken seriously because experience tells one that the picture that emerges at trial, when all the evidence has been examined, often differs markedly from that which presents itself at an earlier stage. For that reason the court on an application for summary judgment will normally accept the parties' evidence at face value, as the judge did in this case, and will refuse to be drawn into an attempt to resolve factual disputes of any kind. However, a party cannot complain if, accepting his evidence at face value, the court adopts a rigorous approach when considering what, if anything, that evidence amounts to. 14. In the present case Allianz criticised the judge for having failed to make allowance in its favour for the likelihood that additional evidence relating to various aspects of this defence would be available at trial to cast a more benevolent light on events, but in my view that criticism is unfounded. It is incumbent on a party responding to an application for summary judgment to put forward sufficient evidence to satisfy the court that it has a real prospect of succeeding at trial. If it wishes to rely on the likelihood that further evidence will be available at that stage, it must substantiate that assertion by describing, at least in general terms, the nature of the evidence, its source and its relevance to the issues before the court. The court may then be able to see that there is some substance in the point and that the party in question is not simply playing for time in the hope that something will turn up. It is not sufficient, therefore, for a party simply to say that further evidence will or may be available, especially when that evidence is, or can be expected to be, already within its possession, as is the case here. Allianz was quite entitled, if it so chose, to confine its evidence to the factual allegations in the defence, but having done so, and having failed to give any indication of what other evidence can be expected to be available at trial, it cannot complain that the court has not speculated about whether there might be any such evidence, and if so what its nature might be.”
“45. I have been told that there has been no reported decision of a successful summary judgment application in a clinical negligence case. As a matter of principle there is no reason why clinical negligence cases are any different from any other case and an obviously weak case on liability or causation is vulnerable to such an application. That said, there will be few cases, in my view, where such an application could ordinarily be contemplated before the relevant experts’ reports have been exchanged and, in most cases, until after the experts have discussed the case and produced a joint statement. Experts do from time to time change their views in the light of discussions with their counterparts and, whilst it is not to be encouraged and is ordinarily unsuccessful, there are occasions when a party will make a credible application to substitute another expert at some stage. This means that the task of considering, on a summary judgment application, evidence “which can reasonably be expected to be available at trial and the lack of it” (see Royal Brompton Hospital NHS Trust v Hammond[2001] EWCA Civ 550 at [19] and Tesco Stores Ltd v Mastercard Incorporated[2015] EWHC 1145 (Ch) at [9]-[10]) is one that needs to be undertaken with caution.”
“I emphasise that in my view it will very seldom be right for a judge to reach the conclusion that views genuinely held by a competent medical expert are unreasonable. The assessment of medical risks and benefits is a matter of clinical judgment which a judge would not normally be able to make without expert evidence. As the quotation from Lord Scarman makes D clear, it would be wrong to allow such assessment to deteriorate into seeking to persuade the judge to prefer one of two views both of which are capable of being logically supported. It is only where a judge can be satisfied that the body of expert opinion cannot be logically supported at all that such opinion will not provide the benchmark by reference to which the defendant's conduct falls to be assessed.”
“In this case (while not specifically pleaded) the Second Defendant accepts that there is a duty to take reasonable care of a person detained in a police station but does not accept the extent of the duty contended for or that there was a breach of that duty that caused the damage sustained by the Claimant.”
“The duty of those who are entrusted with [a prisoner's] custody is to take reasonable care for his safety while he remains in their hands. If it is known that he may engage in self-mutilation or suicide while he is in their custody, their duty is to take reasonable care to prevent him from engaging in these acts so that he remain free from harm until he is set at liberty. This duty is owed to the prisoner if there is that risk, irrespective of whether he is mentally disordered or of sound mind. It arises simply from the fact that he is being detained by them in custody and is known to be at risk of engaging in self-mutilation or of committing suicide.”
“… The position must, in my judgment, be different when one person is in the lawful custody of another, whether that be voluntarily, as is usually the case in a hospital or involuntarily, as when a person is detained by the police or by prison authorities. In such circumstances, there is a duty upon the person having custody of another to take all reasonable steps to avoid acts or omissions which he could reasonably foresee would be likely to harm the person for whom he is responsible.”
“…an important development in this regard in that it contributes significantly to the erosion of the customary divide between the duty of care and breach elements of the action in negligence. The consequence of that erosion is that cases that would previously have been understood as being breach cases are increasingly being treated as – and only as – duty cases. In short, contrary to the conventional structure of the tort of negligence, the breach element of the action is gradually disappearing.”
“The claimant commenced proceedings for damages and the defendant NHS trust admitted that, had the claimant been treated promptly, he would have made a full recovery. Expert witnesses were unanimous in their opinion that the claimant should have been seen by the triage nurse within 30 minutes of arrival at the hospital. However, the trial judge held, amongst other things, that it was not fair, just and reasonable to impose a duty of care on the defendant's reception staff to give accurate information about waiting times, and the claimant's action consequently failed ([2015] EWHC 2301 (QB) ). An appeal to the Court of Appeal was dismissed by a majority (Jackson and Sales LJJ; McCombe LJ dissenting). The majority reasons in Darnley similarly concentrated whether the defendant owed the claimant a duty. That focus was surprising given that it is, of course, trite law that hospitals owe a duty to their patients. The claimant was certainly a patient (or analogous to a patient) on account of his having presented himself at the hospital's accident and emergency department, and no member of the Court of Appeal seemed to suggest otherwise, with all of the Lords Justices referring repeatedly to the claimant as a ‘patient’. Accordingly, on traditional principles, Darnley is not, in fact, a duty of care case at all. Rather, properly understood, the issue was whether the defendant had breached its duty in giving, by its receptionist, inaccurate information to the claimant. The mode of analysis in Darnley is far from atypical. Judges, by over-specifying the content of the duty of care element, routinely treat breach cases as though they were duty cases (another recent illustration is Southern v Adventure Forest Limited[2016] EWCA Civ 1178 , at [31], in which the court held that an occupier did not owe an invitee a duty of care in respect of a particular danger on the premises). Judges who proceed in this way typically utter formulae such as: ‘no duty of care was owed by the defendant in the present case to do [X] because the reasonable person in the defendant's position would not have done [X]. However, the structure of that phrase reveals immediately that the duty of care element is not in play at all. The very fact that the court is discussing what the reasonable person in the defendant's position would have done indicates that the dispute is actually about the breach element, that being the only element of the action in negligence that is concerned with the satisfactoriness of the defendant's conduct … Pursuant to established doctrine, Darnley should have been analysed as follows. Any suggestion that the defendant did not owe the claimant a duty of care should have been given short shrift. That is because Darnley was completely lacking in features that could possibly be thought to have given rise to any duty issue. The parties were within an established duty category. The damage complained of was personal injury rather than (for example) pure mental or economic harm. Neither was there any suggestion that Darnly involved a mere omission. It follows, and follows straightforwardly, that a duty of care was owed to the claimant. The only question in Darnley, relevantly, was whether the defendant breached its duty.”
“14. I consider that the approach of the majority in the Court of Appeal to the issue of duty of care is flawed in a number of respects. … 16. In the present case Jackson LJ observed (at para 53) that to hold the defendant responsible would create ‘a new head of liability for NHS health trusts’. To my mind, however, the present case falls squarely within an established category of duty of care. It has long been established that such a duty is owed by those who provide and run a casualty department to persons presenting themselves complaining of illness or injury and before they are treated or received into care in the hospital’s wards. The duty is one to take reasonable care not to cause physical injury to the patient: Barnett v Chelsea and Kensington Hospital Management Committee[1969] 1 QB 428 , per Nield J, at pp 435–436. In the present case, as soon as the claimant had attended at the defendant’s A & E department seeking medical attention for the injury he had sustained, had provided the information requested by the receptionist and had been ‘booked in’, he was accepted into the system and entered into a relationship with the defendant of patient and health care provider. The damage complained of is physical injury and not economic loss. This is a distinct and recognisable situation in which the law imposes a duty of care. Moreover, the scope of the duty to take reasonable care not to act in such a way as foreseeably to cause such a patient to sustain physical injury clearly extends to a duty to take reasonable care not to provide misleading information which may foreseeably cause physical injury … 21. Thirdly, I consider that the judgments of the majority in the Court of Appeal elide issues of the existence of a duty of care and negligent breach of duty. They place emphasis on what a reasonable person would have done 841and could reasonably be expected to have done in the context of a busy A & E department. Thus Jackson LJ draws attention to the difficult conditions in which staff at such departments often have to work, observing, at para 54, that A & E department waiting areas are not always havens of tranquillity. Similarly, Sales LJ considers, at paras 84–87, that if there is a duty to provide “precise and accurate information” about the length of time before a patient might be seen by a triage nurse, it is difficult to see why it does not extend to an obligation to correct such information as changing pressures on resources arise. He observes, at paras 85, 87, that it would not be fair, just or reasonable to impose “a duty of fine-grained perfection” regarding the information provided and that “it is not as a matter of legal duty incumbent on a receptionist and the employing NHS trust to provide minute-perfect or hour-perfect information about how long the wait might be”
‘Accordingly, on traditional principles, Darnley is not, in fact, a duty of care case at all. Rather, properly understood, the issue was whether the defendant had breached its duty in giving, by its receptionist, inaccurate information to the claimant.’
“27. … The trial judge made the critical finding that it was reasonably foreseeable that a person who believes that it may be four or five hours before he will be seen by a doctor may decide to leave. In the light of that finding I have no doubt that the provision of such misleading information by a receptionist as to the time within which medical assistance might be available was negligent.”
“(ii) Having determined at 3.29 on12 August 2020 that the Claimant required an appropriate adult, failed to ensure that the Claimant underwent an appropriate and effective mental health assessment by a Healthcare Professional to determine if he was fit to be interviewed in accordance withCode C of the Police and Criminal Evidence Act 1984 (‘PACE’) and the College of Policing Authorised Professional Practice. (iii) Upon Mr Parish of the CJLDS failing or being unable to undertake any mental health assessment, failed in any event to ensure that the Claimant underwent an appropriate and effective psychiatric assessment by a Healthcare Professional in accordance with the requirements of Code C of PACE.”
“Where an individual is referred to the service they must be offered a screening appointment to be conducted by an L&D practitioner. The service will screen for a wide range of conditions and vulnerabilities using a trauma informed approach … … Individuals will be offered a further assessment linked to needs identified through the screening process. The service will liaise with any professionals working with the individual to discuss and agree onward referrals.”
“2.8.3 Exclusion criteria The following functions will not be pursued as part of the L&D service: - removal and detention of an individual in accordance withsection 136 of the Mental Health Act 1983 - street triage services - fitness to detain, fitness to interview and pre-release risk assessments - mental Health Act assessments - custodial in-reach services or post release services. However, it will be important for providers of L&D services to build interfaces with providers of the above functions. This service will also address the sharing of relevant flows of information with those providers, to ensure that any relevant diagnoses are made known for the purposes of access to appropriate health and social care services.”
“In September 2019 he was in A+E seeking psychiatric assessment amid concerns of paranoia, delusions and low mood. He left the department after waiting for 8+ hrs and not being seen. At home there was an altercation over the preparation of a sandwich leading him to go to his grandfathers where he ended up assaulting him and causing criminal damage. In custody he saw my CJLDS colleague who referred him for a mental health act assessment. He was detained under section two and admitted to hospital. He was felt to be exhibiting symptoms of a drug induced psychosis and was discharged three days later. He was referred to community mental health services but was not felt to meet the criteria for any service so was subsequently discharged.”
“9.13 Whenever the appropriate healthcare professional is called in accordance with this section to examine or treat a detainee, the custody officer shall ask for their opinion about: • any risks or problems which police need to take into account when making decisions about the detainee’s continued detention; • when to carry out an interview if applicable; and • the need for safeguards. 9.14 When clinical directions are given by the appropriate healthcare professional, whether orally or in writing, and the custody officer has any doubts or is in any way uncertain about any aspect of the directions, the custody officer shall ask for clarification. It is particularly important that directions concerning the frequency of visits are clear, precise and capable of being implemented. See Note 9F.”
“The custody officer should always seek to clarify directions that the detainee requires constant observation or supervision and should ask the appropriate healthcare professional to explain precisely what action needs to be taken to implement such directions.”
“Officers should seek advice from an appropriate HCP [health care professional] if they have concern that a detainee has an injury, medical condition or a mental illness, appears to be experiencing mental ill health or otherwise requires medical attention. This does not apply to minor injuries or ailments, but officers should still note those in the custody record. If unsure of the nature of a condition, officers should call an HCP. See PACE Code C paragraph 9.5 and Notes for Guidance, Note 9C.”
“mood low mood for over 5 years, ‘he’s not felt right’, poor sleep and passive suicidal thoughts last year but tells me he is no longer having it.”
‘… one of the nurses in A&E referred Tyler liaison assessment. Reported that Tyler went missing, found low and suicidal.’
“March 2019 seen by CJLDS … No evidence of mental disorder (He refused assessment – KR) …December 2018 His mother reported that he first reported hearing voices. According to his mother he drove off with a hose pipe threatening suicide. His father found him and stopped him.”
‘There are reports that he has expressed suicidal ideations which he denies.’
“When assessed he was described as having grandiose delusions believing he had been reincarnated into Jesus and had also ran out of the house the night before saying he wanted to kill himself … Risk of harm to self and others on discharge were low however risks are largely impacted on by illicit substance misuse and Tyler is aware of this and need to desist from illicit substance misuse. He has capacity to make decisions around his drug misuse Diagnosis Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances / Psychotic disorder”
“According to history subsequently given by the Claimant’s mother, the Claimant gradually deteriorated over time and demonstrated a number of bizarre behaviours, including talking to voices in an empty bathroom, screaming about people banging doors at home, talking about being God and Jesus and healing the world and thinking that people were coming to kill him. He developed a hatred of the colour red and anyone who wears it and has been witnessed to write pages of “gobbledgook” and fixate on seemingly random themes.”
“During the time at the address, the family have strongly and repeatedly stated that this is a MH episode. I have raised their concerns with Medway Custody and asked for them to update the custody record and that he is assessed by the CPN. The family have stated that they have known this incident is coming for a few days. Yesterday Tyler spent several hours sat in front of a mirror growling at himself. He also continually states that he is Jesus and the messiah. Approximately a year ago Tyler became a HR MISPER. He was later found by the helicopter on a bridge over the A2 threatening to kill himself. He has made repeated threats of suicide and his family are concerned they are seeing the same signs that led up this incident last year. There is also a family history of paranoid schizophrenia. Tyler’s uncle and Marcus’ brother suffered from the same condition and hung himself some years ago. Therefore the family are very passionate about this subject and are adamant that they want him sectioned. They have only plastic cups in the house and the knives have been hidden in an alleyway next to the house because they live in fear as a result of Tyler’s behaviour.”
“(2) An application for admission for assessment may be made in respect of a patient on the grounds that - (a) he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and (b) he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.”
“…Capacity Fully capacitous. Diagnosis Drug induced psychosis. Plan he needs antipsychotic medication. No indication for his prescribed citalopram. Not ready for section 17 leave yet prn medication.”