Protecting Your health

The case of Louis Blehein v St John of God Hospital & the Attorney General centred on the application by Blehein to seek leave of the High Court pursuant to Section 260 of the Mental Treatment Act 1945 to bring proceedings against the defendant institution in connection with the hospital’s exercising of its powers and duties under the act.

Section 260, as amended by Section 2(3) of the Public Authorities (Judicial Proceedings) Act 1954, provides that High Court proceedings shall only be brought against a hospital if there are substantial grounds for contending that the hospital had acted in bad faith or without reasonable care.

In this action, there were seven grounds against the defendant hospital: that Blehein’s detention was based on fraudulent documentation; that there had been a violation of his right to fair procedure, as well as constitutional and natural justice; that there was no statutory authority to his detention; that the compilation of a file/dossier on him by the hospital was a violation of constitutional justice; that the prescribing of and treatment with neuroleptic and psychotropic drugs violated his personal dignity, right to privacy, and bodily integrity; that the prescribing of and treatment with neuroleptic and psychotropic drugs during his detention was an assault, battery against him and a trespass to his person; and that his intoxication with the neuroleptic and psychotropic drugs amounted to torture, inhuman and degrading treatment.

The Supreme Court firstly considered the issue of the fraudulent documentation upon which his detention was based. The basis of the claim was that the Form 7 completed under Section 185 of the 1945 act was invalid.

Section 185 states that when a patient is being detained in a hospital, they should be detained as a temporary and private patient. Blehein argued that paragraph 6 of Form 7 stated that it referred to the reception of the patient, not their detention. However, the court referred to paragraph 10 of the same document, which made reference to the reception and detention in the mental institution of the patient. It also pointed out that the heading for paragraph 6 was “Application, Certificate and Order for the Reception and Detention of a Person as a Temporary Patient and as a Private Patient”. Consequently, the court held that the documentation was in order, and that his detention was valid.

Under the act, the application to receive and detain is to be accompanied by a certificate signed by two registered medical practitioners who have examined that patient separately. The patient’s reception and detention must occur within seven days of these examinations. Under Section 5 of the Mental Treatment Act 1953, if these examinations have been carried out on different dates, that seven-day period runs from the earlier of those dates. The court held that the intention of the legislation was that no person should be detained in a mental institution on the basis of an out-of-date medical examination. Given that in this case the latest examination in question was carried out the day before the order for his reception and detention was made, the detention was lawful and valid.

Blehein also claimed that one of the medical practitioners was not registered, and consequently this violated Section 185(4) of the 1945 act. However, the court referred to the fact that Section 185 (4) mentions that any person specified under the subsection is eligible to “receive and take charge of the person to whom the application relates and detain him until the expiration of a period of 12 hours, or, if the application is granted or refused during that period, until it is granted or refused”. Consequently, the court was of the opinion that subsection 4 would refer to the person in charge of the institution, along with all the officers of the hospital, including any medical officer of the institution.

The applicant in the case then submitted that, under Section 5 of the Mental Treatment Act 1953, he could not be detained for more than 12 hours prior to the making of the order for his reception and detention in the institution. Subsequent information given to the court indicated that the reception and detention of Blehein was completely legitimate.

Another issue raised by Blehein was the degree of investigation, if any, that the institution would have to undertake in respect of the certificates supplied by the medical practitioners in regard to the patient who is presented for admission to the hospital. The court agreed with Blehein’s submission that there was no onus on the institution to investigate the background to any admission. However, it was agreed that this would not prevent the respondent hospital from receiving information that is voluntarily offered by the certifying medical practitioner.

An argument from the plaintiff was that the fact that the hospital had released him on the condition that he would continue to take drugs and undergo certain injections was in fact a reversal of the Common Law presumption of sanity. As no evidence had been presented by the hospital as to his mental condition, and if he was sufficiently recovered to be released from hospital, then he ought to have been released from hospital on the presumption that he was sane. However, the court held that it was common knowledge that hospital in-patients who had suffered from mental illness were released on condition that they continue to take medication as prescribed in order to ensure their continued stability.

The penultimate ground of the appeal was in regard to the claim that the principles of procedural justice were violated in respect of Blehein’s reception and detention at the hospital. The court held that such principles did not apply to the operation of Section 145 of the Mental Health Act 1945 as expanded by Section 5 of the Mental Treatment Act 1953. In order for a person to be detained in a mental hospital under Section 185, the two registered medical practitioners must certify that the person is suffering from mental illness, that they require not more than six months of suitable treatment for their recovery, and that they are unfit, on account of their mental state, for treatment as a voluntary patient. The practitioners must also certify that the said person is an addict and requires at least six months preventive and curative treatment for their recovery.

The court went on to state that if the procedural steps sought by the claimant were to be required in all cases governed by the mental health legislation, then the system would become unworkable. It added that the legislation is in place to protect and treat mentally ill people, and as a consequence there is a justifiable balancing of the patient’s constitutional rights with the requirement to protect and treat them.

Dr Kieran Doran is a solicitor at Beauchamps