Articles & Updates

Rabone v Pennine Care NHS Trust

Pannone acted for the parents of a young woman who took her own life after being allowed home leave from a psychiatric unit. The parents have today won a landmark human rights victory in the Supreme Court after a six-year battle through the courts.

The unanimous ruling means that psychiatric patients at risk will be entitled to the same level of protection whether they are formally detained under the Mental Health Act or not; and the parents of adult children who have died as a result of a failure protect to them in such circumstances will now, for the first time, be entitled to compensation under the Human Rights Act (HRA).

Background
The case was brought by Richard and Gillian Rabone after the death of their daughter, Melanie, in 2005. Melanie had been a psychiatric in-patient at Stepping Hill Hospital, Stockport, under the responsibility of Pennine Care NHS Trust. She was in hospital for her own protection.

Melanie had been suffering from severe depression and, after several attempts to take her own life, she was admitted to hospital. She agreed to informal admission, but the plan was to assess her for detention if she attempted or demanded to leave. On April 11 2005, she was placed on 15 minute observations due to her suicide risk.

Melanie remained on the ward and under that observation regime until she was reviewed on 19 April by a psychiatrist.  He decided she should be allowed home leave for two nights, despite her parents’ serious concerns about his proposal. He advised that Melanie should take responsibility for her own actions. The Trust later admitted that this decision was negligent.

On 20 April, the day after she was allowed home, Melanie went to a local beauty spot where she committed suicide by hanging.

The court proceedings
Mr and Mrs Rabone brought a claim to establish, amongst other things, that the Trust had a duty under Article 2 of the Human Rights Act to protect their daughter’s life, as a non-detained psychiatric patient. Article 2 of the European Convention on Human Rights (ECHR) states: “Everyone’s right to life shall be protected by law”. 

In the context of medical treatment, this means that trusts must ensure that they recruit competent staff, maintain high professional standards and put in place suitable systems of work to protect patients.

However, in certain circumstances, the state must take positive steps to protect the life of a particular patient in their care, if they know or ought to know of a real and immediate risk to that patient’s life. One such circumstance is where a patient is compulsorily detained under the Mental Health Act.

At the initial trial, the High Court ruled that, because Melanie was not detained under the Mental Health Act, the Trust owed no operational obligation to Melanie under article 2 and also ruled that Mr and Mrs Rabone should not be classed as victims under the HRA. Melanie’s family then appealed to the Court of Appeal but their claims were rejected. The Court of Appeal had also held that this positive obligation only arose in the case of detained psychiatric patients. This was because it took the view that non-detained psychiatric patients were no more vulnerable than a patient in an ordinary healthcare setting, such as someone undergoing life-saving surgery.

However, the Supreme Court has now decided that the positive obligation is owed to all psychiatric patients at real and immediate risk of suicide whether detained or not because the state has assumed responsibility for that individual’s welfare and safety and has the power to detain that patient if need be, unlike an ordinary hospital patient. With regard to the position of a patient undergoing treatment for a physical illness, the Supreme Court found that the ordinary patient who undergoes surgery accepts the risk of death on the basis of informed consent and may choose to avoid that risk by deciding not to go ahead with the treatment.

The Supreme Court therefore ruled in favour of Mr and Mrs Rabone, confirming that, as a non-detained patient, the hospital Trust did have an operational duty to protect Melanie’s life under the Human Rights Act; that there was a real and immediate risk of suicide that was known to the hospital and that the Trust failed to do all that could reasonably have been expected to prevent that risk.

With regard to the victim status issue, the Supreme Court held that Mr and Mrs Rabone were direct victims of the breach under the convention. The Court then had to consider whether Mr and Mrs Rabone had lost their victim status. Relevant to this was the fact that the Trust settled a claim on behalf of Melanie’s estate for the funeral expenses and general damages for Melanie's pre-death pain and suffering under the Law Reform (Miscellaneous Provisions) Act 1934, amounting to £7,500.

The Court found, however, that neither Mr nor Mrs Rabone had renounced their own claims under Article 2 for damages for their bereavement as in English law, no such claim could be made – Melanie was an adult at the time of her death and therefore Mr and Mrs Rabone were not entitled to bereavement damages under the Fatal Accidents Act 1976. As a result, the Court awarded Mr and Mrs Rabone £5,000 each to recognise the breach of the HRA.

Further details, including the judgments can be accessed at Rabone & another (Appellants) v Pennine Care NHS Trust (Respondent) [2012] UKSC 2

Emma Holt and Gill Edwards, partners in the clinical negligence group at Pannone, acted for Mr and Mrs Rabone throughout the case.

If you would like to know more about the case or about claims under the Human Rights Act please contact Gill Edwards on 0161 909 4300 or gill.edwards@pannone.co.uk