View source for GA v Betsi Cadwaladr University Local Health Board (2013) UKUT 280 (AAC), (2013) MHLO 50

''(1) Although the patient argued that he was not giving true consent to depot medication on a CTO, the tribunal decided that he was in fact consenting (this finding was not addressed on appeal). (2) If the tribunal have found that the statutory criteria are met (in CTO cases, effectively that the patient requires treatment and should be subject to recall), then, before granting a discretionary discharge, the tribunal must be satisfied that the identified needs for treatment and protection can be properly catered for, as otherwise the decision would be self-contradictory and perverse.'' [A more detailed summary is available on the case page.]

==Detailed summary==
It was a condition of the CTO that the patient 'will take depot injections as prescribed'. At the tribunal the patient argued that he should be discharged as he was not giving true consent - he was only consenting in order to remain out of hospital. 

The tribunal concluded that GA did consent. It continued: 'Should the Patient refuse that injection, as is his right, the Tribunal feels that he is aware of the consequences that may follow. The Tribunal unanimously agree this is not undue or unfair pressure but the reality of the situation.'

On appeal, he argued that the tribunal were wrong to find that he consented, that the condition was unlawful which meant the CTO was unlawful, and therefore the tribunal should have discharged under its discretionary power.

The Upper Tribunal judge did not address the tribunal's decision on consent. He considered the case 'for the sake of argument only' on the assumption that GA did not consent and that the tribunal's finding was perverse.

He then considered the scope of the discretionary power. The issue of consent could not be excluded from this (as it was excluded from mandatory discharge in [[SH v Cornwall Partnership NHS Trust (2012) UKUT 290 (AAC), (2012) MHLO 143]]). However, tribunal exercising its discretionary power must act consistently with the logic of its reasoning.

The judgment at this point is hard to follow but appears to say this. If the tribunal have found that the statutory criteria are met (in CTO cases, effectively that the patient requires treatment and should be subject to recall), then before discharging the tribunal must be satisfied that the identified needs for treatment and protection can be properly catered for. Otherwise the decision would be self-contradictory and perverse. The tribunal could only discharge on the basis that the tribunal was satisfied that (a) the patient would again be placed under the MHA, or (b) the patient lacked capacity and would be treated under the MCA. The discretionary power can therefore be used 'in exceptional circumstances only' such as 'a tribunal using its power to allow a patient to join his parents in the USA, where he could receive treatment'.

This judgment at first glance may appear unduly to narrow the scope of the discretionary discharge power. However, might it not instead be that that the continued existence of the this power is simply a drafting oversight and logically ought to have been removed when the 'burden of proof' was amended in 2001? Postscript: See [[PJ v A Local Health Board (2015) UKUT 480 (AAC)]].

==MHLR==
{{MHLR|2014|27}}

==Citations==
Spelt as GA v Betsi Cadwaladrv University LHB on transcript and on Bailii

==External link==
{{#bailii:(2013) UKUT 280 (AAC)}}

[[Media:GA v Betsi Cadwaladr University Local Health Board (2013) UKUT 280 (AAC), (2013) MHLO 50.pdf|Transcript]]

[http://www.osscsc.gov.uk/Aspx/view.aspx?id=3851 OSSCSC website]

[[Category:Upper Tribunal decisions]]
[[Category:CTO cases]]
[[Category:Detailed summary]]
[[Category:Transcript]]
[[Category:2013 cases]]