R (YZ) v NHS Trust  EWHC 2296 (Admin),  MHLO 58
(1) YZ ceased to comply with clozapine treatment, and was referred by a medium secure unit (MSU) to Broadmoor hospital. After Broadmoor's Admission Panel decided that while off clozapine the risks justified a high secure setting, YZ became willing to restart clozapine but his new doctor at the MSU was unwilling to prescribe it. YZ appealed the Admission Panel decision and argued that new information meant the case should be reconsidered by the original panel, but Broadmoor decided there was no new information so the case was considered by the Admission Appeals Panel, which upheld the decision. (2) YZ's position was that he could restart clozapine in medium security, the relationship with staff at the MSU had broken down but he should be transferred to another MSU, and once treatment of his gender dysphoria commenced his mental state would probably improve. He argued that transfer to Broadmoor would breach the Code of Practice's least restriction principle and violate Articles 3 and 8. He sought judicial review of: (a) the decision not to prescribe clozapine; (b) the decision to transfer him to Broadmoor; (c) Broadmoor's decision to accept him; (d) the decision not to refer the case back to the original admissions panel. (3) Taking the grounds in turn, the court held that: (a) There was no clinician willing to prescribe clozapine, and the court "cannot and should not seek to decide what medical treatment is appropriate in these circumstances and declare an informed and justified decision unlawful". (b) The decision to transfer to Broadmoor was taken carefully and through the correct procedures, and no medium secure unit was willing to take the patient. (c) The decision to accept was a rational decision open to the admissions panel on the material before it. (d) The appeals panel decision was not susceptible to judicial review, and the process was rational and had not been challenged at the time. Permission was therefore refused.