CORONER — Inquest — Verdict — Inquest into death of patient detained in mental health unit — Whether enhanced investigation required — Human Rights Act 1998, Sch 1, Pt I, art 2
An inquest into the death of a patient who was detained in a hospital under s 3 of the Mental Health Act 1983 had to satisfy the enhanced requirements of art 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms which guaranteed the right to life.
The Court of Appeal so held when dismissing the appeal of the claimant, Ralph Allen, the husband of the deceased patient, against the decision of Blake J on 23 September 2008 refusing the claimant’s renewed application for permission to apply for judicial review of decisions made by the Inner North London Coroner at the inquest into the death of Mrs Allen. The judge refused the application on the ground, inter alia, that a broader inquest of the kind required by art 2 of the Convention was not necessary because art 2 was not engaged.
DYSON LJ, giving the judgment of the court, said that the judge had been wrong to hold that art 2 was not engaged and there was no support in the authorities for his approach. The reasoning in R (L (A Patient)) v Secretary of State for Justice (Equality and Human Rights Commission intervening)  3 WLR 1325, para 59 applied, where it was held that, after a suicide or attempted suicide in a prison, there had to be an investigation to find out if something did go wrong. In the instant case Mrs Allen had been detained by the state as a mental patient in a hospital. It was possible that the medical authorities had failed in their obligation to take general measures to save her from dying. That was sufficient to trigger an art 2 investigation since, without it, one might never know. A further reason for an art 2 investigation might have been the possibility that death was caused by a breach of the operational obligation to take steps to save Mrs Allen from death. However, although the judge had held that art 2 was not engaged, it was in fact common ground before the coroner that the inquest had to satisfy the requirements of art 2. The coroner had not only been aware of art 2 but had intended to conduct the inquest in accordance with its requirements as explained in R (Middleton) v West Somerset Coroner  2 AC 182. As far as the claimant’s criticisms of the inquest were concerned, none of the complaints were made out. It was not incumbent on the coroner to investigate, still less to state his conclusion in relation to every issue raised by the claimant. The coroner was required to do no more than focus the investigation and the inquisition on the central issues in the case. The judge had been correct to refuse permission to apply for judicial review, although not for entirely the right reasons, and the appeal would be dismissed.
 EWCA Civ 623;  WLR (D) 219
CA: Sir Anthony May P, Dyson, Hooper LJJ: 30 June 2009
Appearances: Leslie Thomas (instructed by Bindman & Partners) for the claimant; the coroner did not appear and was not represented.
Reported by: Susanne Rook, barrister