L.B. v Clinical Director of Naas General Hospital

JurisdictionIreland
JudgeMs. Justice Iseult O'Malley
Judgment Date27 January 2015
Neutral Citation[2015] IEHC 34
CourtHigh Court
Date27 January 2015

[2015] IEHC 34

THE HIGH COURT

[Record No: 63 SS/2015]
B (L) v Clinical Director of Naas Hospital
No Redaction Needed
IN THE MATTER OF AN APPLICATION PURSUANT TO ARTICLE 40.4.2 OF THE CONSTITUTION
BETWEEN/
L.B.
Applicant

AND

THE CLINICAL DIRECTOR OF NAAS GENERAL HOSPITAL
Respondent

Mental Health – Involuntary detention – s. 10 of the Mental Health Act 2001 – Medical Examinations

Facts: The adequacy of a medical examination of the applicant by her GP was the central issue in this case. The GP made a recommendation for the applicant”s involuntary admission to hospital under the provisions of the Mental Health Act 2001. The applicant contended that the medical examination had been so inadequate that it amounted to a fundamental failure to comply with the statutory requirements. When a recommendation under the Act has been received by the clinical director of a hospital a person will be examined by a consultant psychiatrist on their staff. An admission order will only be made if the psychiatrist is satisfied that the person is suffering from a mental disorder. The applicant was admitted to hospital and the Mental Health Tribunal concluded that the applicant continued to suffer from psychosis and therefore needed to be treated on an involuntary basis. The Tribunal renewed the admission order.

Held by O”Malley J: The court considered the general principles and authorities in relation to the requirements under s. 10 of the Mental Health Act 2001. It determined that the application failed. The GP”s knowledge of the applicant”s medical history; the information supplied by the applicant”s family and the evidence supplied by the clinical director of the Mental Health Services unit where the applicant was admitted meant that the examination could not be described as inadequate for the purposes of s. 10. The court also determined that the GP”s personal connection to the family did not disqualify her from acting on her views and making a recommendation. The court also pointed out that provided a practitioner makes an examination of some sort, the validity of detention falls to be considered by reference to the admission order made by the consultant psychiatrist of the hospital. The applicant did not raise this as an issue and the court therefore refused the relief sought.

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JUDGMENT of Ms. Justice Iseult O'Malley delivered the 27th January, 2015

Introduction
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1. The central issue in this case concerns the adequacy of an examination of the applicant carried out by her general practitioner prior to the making of a recommendation for her involuntary admission to hospital under the provisions of the Mental Health Act, 2001. The applicant says that the doctor had already formed a view of her mental state to the extent that she had prejudged the issue, and that the purported examination was so inadequate as to amount to a fundamental failure to comply with the statutory requirements.

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2. Section 9 of the Act provides for an application to be made by, inter alia, a relative of the person concerned to a registered medical practitioner for a recommendation that the person be made the subject of an involuntary admission. The application may not be made unless the applicant has observed the person within the previous 48 hours.

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3. Section 10 of the Act reads, in relevant part, as follows:

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(1) Where a registered medical practitioner is satisfied following an examination of the person the subject of the application that the person is suffering from a mental disorder, he or she shall make a recommendation (in this Act referred to as "a recommendation") in a form specified by the Commission that the person be involuntarily admitted to an approved centre (other than the Central Mental Hospital) specified by him or her in the recommendation.

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(2) An examination of the person the subject of the application shall be carried out within 24 hours of the receipt of the application and the registered medical practitioner concerned shall inform the person of the purpose of the examination unless in his or her view the provision of such information might be prejudicial to the person's mental health, well-being or emotional condition."

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4. An "examination", for the purposes of a recommendation, is defined in s.2 (1) as meaning

"a personal examination carried out by the registered medical practitioner …of the process and content of thought, the mood and the behaviour of the person concerned."

Background facts
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5. It appears that the practitioner in question, Dr. K., has known the applicant and her family for several years. The applicant suffers from Graves' disease and attended Dr. K. on a number of occasions during 2014 with various symptoms. Dr. K. has said that her view is that the applicant commenced showing signs of mental illness from about May of 2014.

First involuntary admission
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6. On the 16 th November, 2014 the applicant was the subject of an involuntary admission. She believes that her mother and her stepfather brought this about because she had had a "major falling out" with her mother and as a result was "very stressed and upset". Dr. K. had signed the recommendation on that occasion also and the mode of examination was challenged at a hearing before the Mental Health tribunal on the 4 th December, 2014. Briefly, the doctor had gone to the applicant's home in the company of the applicant's mother and uncle. The applicant declined to admit her but spoke to her through an intercom.

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7. Dr. K's recommendation for involuntary admission was based on her view that the applicant was

"Aggressive, making false claims, locking herself in her home away from her family. She is paranoid."

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8. The consultant who signed the admission order recorded the following:

"She has persecutory beliefs about mother and family. She is without insight into her illness and does not wish to stay in hospital and is suspicious about treatment."

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9. At the Tribunal hearing, the applicant's solicitor submitted that Dr. K. had not, in the circumstances, carried out a medical examination. In ruling on the matter, the Tribunal said that it was satisfied from the applicant's own evidence that she had a sufficient conversation with the doctor so as to enable the latter to reach a decision as to making a recommendation. However, the admission order was revoked. The treating psychiatrist gave evidence that she was considering her discharge as of that day, and the tribunal concluded that the applicant had recovered in the intervening period to such an extent that, while she had a mental disorder, it did not meet the severity criteria set out in the Act. It was noted that the applicant was agreeable to taking prescribed medication and attending day hospital.

The second admission
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10. On the 23 rd December, 2014 the applicant's mother contacted the Gardaí expressing concern about her daughter. The Gardaí in turn contacted Dr. K., who requested them to assist her in carrying out an assessment. It appears from the Garda account of events that an arrangement was made to meet the applicant at her home. They attended there with Dr. K., who had arranged for an ambulance to be on standby. However, the applicant was not there. Contact was made with her and it transpired that she was in a local town with her boyfriend. The Gardaí and Dr. K. then went to the town. Dr. K. met with the applicant and her stepfather in circumstances considered in detail below.

Evidence relating to Dr. K's examination
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11. According to the affidavits sworn by the applicant and her boyfriend, they were sitting in a car when the Gardaí approached them. The applicant says that she was asked for identification, which she provided. She complains that the Gardaí searched her car, and her boyfriend's person, without justification. She says that the Gardaí then asked her to come with them to the Garda Station as she was "very unwell". She says that nothing had happened during the interaction with the Gardaí to give them that impression. However, because she wanted to get out of the public view and because there were five Gardaí present, she went to the station. She says that she did not feel free to do otherwise.

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12. The Gardaí say that the applicant was informed in the street that her mother had expressed concern about her health. She was asked would she consent to an assessment by Dr. K. and she said she would. As the weather was very bad, she was invited to have the assessment carried out in the Garda station.

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13. It is stressed by the Gardaí that the applicant was not arrested or detained. They say that their involvement was solely to prevent a breach of the peace.

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14. The applicant arrived at the Garda station at about 3 o'clock.

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15. At the station, the applicant says that she was sitting in a room when her stepfather and Dr. K appeared and stood in the doorway. Her stepfather

"…simply said 'the texts L, the texts' and Dr. K. then simply said to me 'you're very unwell L., you're very sick L. ah come on L., ah come on."

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16. The applicant deposes that prior to this she had not seen her stepfather since the 9 th November, 2014 and had not seen Dr. K. since the events of the 15 th November, 2014.

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17. In oral evidence, Dr. K said that she had been contacted by the Gardaí, who told her that there was a concern about the applicant threatening her mother. Dr. K said that she too was concerned as the applicant was not taking her medication and had only once attended the out-patient department since her previous certification. Dr. K. said that she was aware that the applicant had transferred €40,000 from her grand-uncle's bank account to her own without his consent and had also taken out €2,000 in cash.

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18. Describing the meeting at the Garda station, Dr....

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1 firm's commentaries
  • Mental Health Case Law Update
    • Ireland
    • Mondaq Ireland
    • May 13, 2015
    ...or renewal order can taint a subsequent renewal order. Section 10 Examinations LB v The Clinical Director of Naas General Hospital [2015] IEHC 34 The High Court rejected a challenge to the adequacy of a section 10 examination carried out on the applicant prior to the making of a recommendat......

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