piBlawg

the personal injury and clinical negligence blog

A collaboration between Rebmark Legal Solutions and 1 Chancery Lane

Clean air: a claim under Article 2?

In February 2013 nine-year-old Ella Kissi-Debrah from Hither Green in South London died after suffering a severe asthma attack. “Can the courts be used to establish that we have a human right to clean air?” asked Nick Robinson on the Today Programme this morning. A report by Royal College of Physicians has apparently linked 40,000 deaths to pollution each year.  A successful case against the government would arguably put the government under considerable pressure as well as resulting in justice for affected families. Ella’s mother and her lawyer were interviewed on the programme. Ella had very severe asthma. According to the Today Programme, nitrogen dioxide levels around their home on the South Circular are double the EU legal limit. Her lawyer, Jocelyn Cockburn, a partner at Hodge Jones & Allen, commented that the coroner had not looked into pollution as a cause of death. The immediate objective, she said, was to try and get a wider investigation into pollution and whether it contributed to Ella’s death. She is seeking to do this by bringing a claim against Lewisham Council and the Mayor of London. She said that they were considering whether or not a case could be brought against the UK government under Article 2 of the European Convention on Human Rights (the Right to Life) on the basis that the government knew that Ella was at immediate risk. There is clearly a long way to go in terms of establishing causation and a claim, but this will be one to keep a close eye on. The full interview can be heard on http://www.bbc.co.uk/programmes/b07dkk07#play

Daniel v St George's Healthcare NHS Trust & London Ambulance Service: a human rights cautionary tale?

  Daniel v St George’s Healthcare NHS Trust  and London Ambulance Service [2016] EWHC 23 (QB) Introduction Edward Bishop QC has successfully defended an NHS trust and the London Ambulance Service against claims under the Human Rights Act 1998 brought by the foster family of a man who died of a heart attack in Wandsworth Prison.  The judgment deals with the legal test for liability, causation and victim status.     The central allegation was that there was culpable delay in the attendance of paramedics caused by nursing error and an insufficiently flexible ambulance triage system.  The judge rejected both allegations on the facts and clarified the law on causation in cases of death in custody from natural causes.  She also dealt with “victim status” under the HRA, ruling that the deceased’s foster mother was entitled to bring a claim but his “foster brother” was not. Background James Best (“JB”) was a prisoner on remand at Her Majesty’s Prison (HMP) Wandsworth when he died from natural causes on 8 September 2011. He suffered a myocardial infarction (a heart attack), as a result of a ruptured plaque in the coronary artery, which caused cardiac arrest and death. He was only 37. He had no previous history of heart disease and it is likely that the plaque was ruptured by over-exertion in the prison gym. The First Defendant (“St George’s”) is a National Health Service (“NHS”) Trust responsible for the provision of primary health care within HMP Wandsworth. Doctors and nurses employed by the First Defendant in the Department of Primary Care at HMP Wandsworth tried unsuccessfully to save JB’s life on the day of his death. The Second Defendant (“the LAS”) is a NHS Trust responsible for the provision of ambulances within the London area. HMP Wandsworth is within its catchment area. On 8 September 2011, an emergency call for an ambulance for JB was made, but he was dead by the time the ambulance arrived. The central allegations were that the nurse who attended on JB in his cell failed to request an ambulance quickly enough, and further that there was unnecessary and unreasonable delay in the dispatch of an ambulance by the LAS. The Claimants had a close relationship with JB which began when the First Claimant fostered JB for 3 years when he was a teenager, between 1988 and 1991. The Second Claimant is the First Claimant’s biological son, and described JB as his foster brother. The Claimants have brought their claim for declarations and damages under the Human Rights Act 1998 (“HRA 1998”), alleging that the First and Second Defendants, as public authorities, acted in breach of Articles 2 and 3 of the European Convention on Human Rights (“ECHR”). Violation of Articles 2 and 3 Mrs Justice Lang set out the appropriate legal test to be applied when considering whether or not there had been a breach. She reiterated the guidance: “I remind myself that the test to be applied is whether the Defendants did “all that could reasonably be expected of them to avoid a real and immediate risk to life of which they have or ought to have knowledge” (Osman at [116]). In Rabone, Lord Dyson considered that an “immediate” risk was one which “present and continuing” (at [39]). He added, at [43]:   “The standard required for the performance of the operational duty is one of reasonableness. This brings in “consideration of the circumstances of the case, the ease or difficulty of taking precautions and the resources available”; per Lord Carswell In re Officer L [2007] 1 WLR 2135 , para 21.   The ECtHR and the domestic courts have emphasised that the operational duty must not be interpreted in a way “which imposes an impossible or disproportionate burden on the authorities” (Osman at [116])”   On causation, and having considered the evidence, the test was: “the legal test of causation is whether there was a failure to take reasonably available measures which could have had a “real prospect of altering the outcome”. Put another way, the Claimants have to establish that JB “lost a substantial chance of avoiding the outcome”.”   The court heard extensive evidence, not just from the actual persons involved in the immediate aftermath, but also from medical experts who gave evidence on the chances of survival following such a heart attack. Careful consideration was given to transcripts of the 999 call-outs, and the exact timing of those calls. The criteria and policy of the ambulance service was scrutinised.   Mrs Justice Lang was emphatic in her dismissal of the claims of breach. She did not consider that the “Claimants have succeeded in establishing, on the balance of probabilities, that, even if [the nurse at the prison] had called an ambulance earlier, or LAS had dispatched an ambulance sooner, that there would have been a “real prospect of altering the outcome” or that JB “lost a substantial chance of avoiding the outcome”.   As for the claims brought under Article 3, the Judge said: “The claim under Article 3 was unarguable, in my view. [the prison nurse] acted promptly, reasonably and professionally and did all she could to save JB’s life. There was no unreasonable delay in calling an ambulance. The LAS handled the emergency call in accordance with their procedures which were required to ensure that a limited resource of emergency vehicles and personnel were allocated fairly within the community according to priority need. ” It certainly did not amount to “inhuman and degrading treatment”.   Victim status   Both Claimants brought claims alleging that they were “indirect victims”. Mrs Justice Lang considered the law on victim status, and set out the relevant test:   “In my judgment, the likely approach of the ECtHR in determining the status of the Claimants in this case would be to consider all the facts and circumstances to assess: ·       1. the nature of the legal/family relationship between the Claimants and JB; ·       2. the nature of the personal ties between the Claimants and JB; ·       3. the extent to which the alleged violations of the Convention (1) affected them personally and (2) caused them to suffer; ·       4. involvement in the proceedings arising out of JB’s death.”   On applying that criteria, she was satisfied that the first Claimant was a indirect victim as she had been JB’s foster mother for three years, leading to a longstanding parent-child relationship. JB had no other family of his own, and shortly before his death referred to himself as the first Claimant’s “third son”. Not only this, but the first Claimant had clearly suffered from acute distress following JB’s demise, and had been extremely active in the aftermath of his death.   However, the second Claimant was found not be an indirect victim. The status of “foster brother” is not recognised in UK domestic law or in ECtHR case law. There can be no question that the second Claimant suffered hugely from the loss of a close friend; but this alone is not a sufficient basis on which to found a claim.   The claims were dismissed.

Records of Inquest: the conclusion is... use your boxes correctly and keep it succinct

For those of you practising in coronial law, the Chief Coroner's Guidance No. 17 was published on 30 January 2015. It contains some useful and succinct guidance on short form conclusions and narrative conclusions, including: how and when they should be used (as alternatives or together); the correct approach to the three stages of the conclusion (i.e. fact finding, box 3 of the Record of Inquest and box 4 of the Record of Inquest); standards of proof; and a summary of the 'ingredients' of the common short form conclusions. The guidance is by no means a full and comprehensive review of the law, but it certainly provides clarity and is likely to be a useful reference when dealing with submissions on conclusions.   The guidance can be downloaded at http://judiciary.go.uk/related-offices-and-bodies/office-chief-coroner/guidance-law-sheets/coroners-guidance/ 

Coroners, Consistency and Change

  Harold Macmillan is famously said to have observed that:   “There are three bodies no sensible man directly challenges: the Roman Catholic Church, the Brigade of Guards and the National Union of Mineworkers”.   To this list should perhaps be added the Royal British Legion.   The Coroners and Justice Act (CJA) 2009 contained legislation to reform the process of death investigation and certification in England and Wales to deal with the shortcomings of single doctor death certification identified in the Shipman Inquiries. It also created the new office of Chief Coroner (CC).     In October 2010, Jonathan Djanogly, then Parliamentary Under-Secretary of State for Justice announced that some of the provisions of the CJA 2009 would not be implemented. These included the office of CC.   Following widespread public criticism, including a message to all members of parliament from the Royal British Legion which appeared prominently in a number of national newspapers, the government relented.   Kenneth Clarke, then the Justice Secretary, announced that he had “listened and reflected on the concerns” and the office of CC would be created after all.   In May 2012 the Lord Chief Justice in consultation with the Lord Chancellor appointed Judge Peter Thornton Q.C. as the first CC of England and Wales.   On 1 July 2014 the CC presented to the Lord Chancellor his first annual report which can be downloaded free of charge from the government’s website:   https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/330652/chief-coroner-annual-report-july-2014.pdf   The report covers the period from 25 July 2013 to 30 June 2014 and contains information which will be of interest and help to all lawyers doing coronial work. In particular the report includes sections on:   The training of and the guidance now provided to coroners. The appointment of coroners and the merging of certain coroner areas. Investigation and inquest processes. Delays in investigations. Prevention of future death reports.   As the report recognises much work still needs to be done. But the CC can take credit for the fact that more hearings are now held in public, all hearings are recorded, most inquests are or soon will be held within six months and there is now better and earlier disclosure to interested parties.   Currently in England and Wales there are 99 separate coroner areas. We await with interest next year’s report to see if the CC’s stated intention to reduce these to about 75 areas, each being an appropriate size in terms of numbers of deaths reported geographically and special work - prisons, major hospitals, mental health institutions and airports – will result in further improvements to the coronial service overall.

Chief Coroner gives Guidance about Pre Inquest Review Hearings

      The unpredictability and inconsistency of coroners in their approach to inquests and the hearings that lead up to them has been a common moan for many years amongst those of us who practice in this field.  Pre inquest hearings in particular have been very much an unknown.  Some coroners make extensive use of them, actively case managing the inquest process and ensuring everyone is clear on the issues.  Others rarely hold them and, if they do, their purpose can be unclear.  Part of the role of the Chief Coroner is to improve consistency and he has taken the opportunity to give guidance about good practice at pre inquest review hearings in the recent case of Brown v HM Coroner for Norfolk [2014] EWHC 187 (Admin).  The facts of the case are involved and do not need to be delved into for the purposes of this post.  His Honor Judge Thornton QC has neatly set out the guidance in his judgment, which is largely restricted to this issue and may be found from paragraph 38.   In summary the guidance given is this: A pre-inquest review hearing, where held, is an important stage. In each case, the coroner should ensure that all interested persons, particularly bereaved families, have sufficient notice of the matters to be discussed. Coroners should provide a written agenda in advance and, if appropriate, express provisional views so that agreement or opposition may be expressed. The agenda should include, particularly in the more complex or difficult cases, the following: a list of interested persons; a proposed list of witnesses, identifying those who might be called and those whose statements might be read; the issues to be considered at the inquest; the scope of the evidence; a statement as to whether a jury will be required; a statement as to whether the European Convention on Human Rights 1950 art.2 is engaged; any issues of disclosure; the date of the final hearing and any other relevant matters. In a complex or difficult investigation interested persons should be invited to respond to the coroner's agenda in advance of the pre-inquest review hearing in writing, stating what they agreed with and what they disagreed with. The coroner should also ensure that interested persons, particularly those who are unrepresented, have sufficient disclosure of relevant statements and documents before the hearing so as to be able to address the agenda on an informed basis. Coroners should avoid giving the impression at a pre-inquest review hearing (and in any documentation supplied before it) that the findings and conclusions of the inquest are in any way predetermined, even when the evidence points substantially in one direction. It might be necessary to explain in clear language to unrepresented families that there is a difference between seeking to identify the key issues and reaching a final conclusion. Coroners should at all times take care in their dealings with interested persons not to give the impression of bias or favouritism. Coroners might need to communicate with police officers investigating on their behalf but their communications, whether oral or written, should be made in such a way that they would not cause concern to others that their interests were being treated as secondary. A coroner should therefore be careful in correspondence with an interested person, such as the police, not to appear to be too familiar with or close to the correspondent; he should also not encourage familiarity from the correspondent, even though he might have got to know the correspondent well in the course of his work as a coroner. Coroners should only write letters (and emails) in the course of their work that would stand the test of looking fair and unbiased if read out in court in litigation. Whether the above is adopted by all those who ought remains to be seen, but it is a good start in providing some standardised guidance about what parties might expect to see and know before a pre inquest hearing and how these hearings should be dealt with in the future.  Here's hoping that the reality meets the expectation.    

Government U Turn on the office of Chief Coroner

Those of you who have any regular involvement in or contact with the coronial process will no doubt have shared my sinking feeling when it was announced during the bonfire of the quangos that the office of Chief Coroner was not going to be implemented.  I was surprised and pleased to see that yesterday Ken Clarke announced a u-turn on this issue, although in limited form. The background to this development is that the Coroners and Justice Act 2009 provided for the appointment of a Chief Coroner and Deputy Chief Coroner.  The purpose of these roles was to provide national leadership for the coronial system in England and Wales, with aims to improve standards.  The Chief Coroner was also intended to provide a new route of appeal from inquests, removing the cumbersome and expensive requirement to judicially review decisions, however small.  In October 2010 the government announced that, in the current economic climate, plans to implement the office of Chief Coroner would not proceed.  The government proposed to abolish the office of the Chief Coroner and to transfer some of the Chief Coroner’s functions to alternative bodies.  The Public Bodies Bill was the means by which it was intended that the office would be abolished, although the provision enacting this power was defeated in the House of Lords in December 2010.  Thereafter the plan became not to abolish the office, but to provide that the functions could be transferred elsewhere.  The plan not to enact the office of Chief Coroner has been very unpopular and heavy opposition has been mounted by charities such as the Royal British Legion.  Yesterday Mr Clarke said in a statement: "Over recent months I have listened to and reflected on the concerns raised across Parliament, by families and by other groups, including the Royal British Legion, that a single figure needs to be responsible for the coroner system. "I am prepared to have one last try to meet those arguments and so have taken the decision to implement the office of the chief coroner. "The existing mechanisms for challenging a coroner's decision will remain in place and will avoid the need for expensive new appeal rights. The new post will be focused on working to deliver the reform to coroners' services that we all want to see and which I previously argued should be delivered by the Lord Chief Justice and myself. "Everyone is agreed that the priority is raising the standards of coroners' inquiries and inquests to ensure that bereaved families are satisfied with the whole process. "I am therefore giving the chief coroner the full range of powers to drive up standards, including coroner training, as well as setting minimum standards of service through the new Charter." So... partial good news then.  The central oversight of the coronial system that is so desperately needed will be implemented.  Unfortunately however, we are stuck with JR for the foreseeable future as the route of appeal against controversial decisions.