B, R (on the application of) v GSL UK Ltd

Handcuffing a prisoner during hospital treatment engages a fact-sensitive assessment of security, medical needs and Convention rights. The legality of restraints depends on whether the force and public exposure reasonably appear necessary in the circumstances. Prison authorities retain a discretion to conduct an individual risk assessment and are entitled to substantial respect for their experience and information. A prisoner's serious conviction, category, conduct in custody and medical condition must be assessed together; none is necessarily decisive. Medical confidentiality is also relevant under Article 8, but interference may be proportionate where security considerations justify it and reasonable efforts are made to protect privacy. The court should not substitute its own assessment unless the decision is clearly wrong, unlawful, irrational or incompatible with the Convention.

The claimant, a serving prisoner convicted of conspiracy to cause an explosion, challenged security measures used while he received treatment for testicular cancer. He complained that he was handcuffed or attached to an escort chain during journeys, consultations, treatment and the taking of medical samples. He alleged breaches of Articles 3 and 8 of the European Convention on Human Rights.

The defendant relied on individual risk assessments, the claimant’s conviction and associations, the security vulnerability of hospital visits, and the absence of medical objection. The central issues were whether the restraints were disproportionate or otherwise unlawful, whether the decision-making process was flawed, and whether interference with medical confidentiality was justified.

1. Application refused. The claimant did not establish a breach of Articles 3 or 8 of the European Convention on Human Rights.
2. Article 3 is not infringed by restraints imposed during lawful detention where the force and public exposure do not exceed what the public authority reasonably considers necessary. The issue is fact-sensitive and includes whether the decision was unreasonable or unlawful. The court must not substitute its own view for that of the decision-maker, but must respect the decision-maker’s experience, expertise and information unless the decision is clearly wrong or Convention rights have been breached.
3. Prison policies indicating that restraints should normally be removed for medical consultation or treatment remain subject to individual risk assessment and judgment. Hospital visits are recognised as a particular security vulnerability. The relevant assessment may take account of the seriousness and nature of the offence, possible associates, escape risks outside prison, current intelligence, medical fitness, previous conduct and the circumstances of the particular visit. The claimant’s category C status and good conduct did not compel a finding that restraints were unnecessary.
4. The case was materially different from Mouisel v France [2004] 38 EHRR 34. Here, the claimant was medically fit, there were no medical contraindications to restraints, risk assessments were completed for each visit, and the approach was not a blanket policy. Defects in record-keeping did not render the decision-making process unlawful. Flexibility was shown where medical staff raised concerns, and an independent expert considered the arrangements appropriate.
5. There had been some interference with medical confidentiality for Article 8 purposes. That interference was proportionate because efforts were made to protect confidentiality where security allowed, medical staff raised no complaint, and there was no evidence of disclosure of confidential information. The later reduction to single handcuffing reflected changed circumstances and did not prove that the earlier decisions were unlawful.
6. The application for permission to appeal was refused. Costs were to follow the event, not to be enforced pending assessment pursuant to section 11 of the Access to Justice Act 1999.

The judgment is a first-instance decision of the Administrative Court. Permission to bring the judicial review claim had been granted by a single judge on 28 March. The application was then refused by Mrs Justice Dobbs. Permission to appeal was refused for lack of a real prospect of success and no other pressing reason for the Court of Appeal to deal with the case.