Hall, R (on the application of) v University College London Hospitals NHS Foundation Trust & Anor

The court refused permission to proceed with the claimant's judicial review challenge to his treatment and proposed discharge from hospital. The principal legal issues were whether state detention and treatment in prison engaged Article 2 (right to life), Article 3 (prohibition of torture and inhuman or degrading treatment) and Article 8 (private and family life) of the European Convention on Human Rights, and whether the prison breached section 19 of the Equality Act 2010 by failing to make reasonable adjustments. The court applied the established thresholds: Article 2 is engaged only where there is a real and immediate risk to life, and Article 3 requires a high minimum level of severity. The court found no evidential basis for an arguable Article 2 breach, concluding the claimant's acute deterioration was explained by thyrotoxicosis related to prior amiodarone therapy and not by systemic failure of prison care. The Article 3 and Article 8 claims were held not arguable because the conditions and incidents relied upon fell well below the high threshold required. The Equality Act claim failed on the evidence: the prison had taken or planned reasonable steps and no unlawful failure to make reasonable adjustments was established. The court also found the hospital's clinical decision that the claimant could be discharged to prison was a considered clinical judgment unimpeachable on the material before the court.

The claimant, suffering from progressive Friedreich's ataxia and dependent on two-person care, was convicted for involvement in drug importation and sentenced to custody. During transfer through Heathrow a concealed quantity of cocaine was found; he pleaded guilty and was sentenced to three years' imprisonment. After a period in the prison health wing the claimant was admitted to hospital on 22 August 2012 with atrial fibrillation and severe thyrotoxicosis; he subsequently required critical care and ventilatory support for a short period and was treated by a multi-disciplinary hospital team.

The claimant issued judicial review claims alleging (i) breach of Article 2 ECHR because prison treatment put his life at risk and reduced life expectancy, (ii) breach of Articles 3 and 8 for degrading and invasive treatment in prison, and (iii) breach of section 19 Equality Act 2010 for failure to make reasonable adjustments. He sought an order restraining discharge to prison and a declaration of unlawful discrimination. An interim order had restrained discharge pending these proceedings.

The court framed the issues as: (i) whether there was a real and immediate risk to life engaging Article 2; (ii) whether the prison regime and specific incidents met the high minimum level of severity for Article 3; (iii) whether Article 8 was engaged in circumstances where Article 3 failed; and (iv) whether the prison failed to take reasonable steps under section 19 Equality Act 2010.

On the evidence the court concluded the claimant's acute deterioration was attributable to thyrotoxicosis arising from long-term amiodarone use, a condition with delayed effects after the drug was stopped, and not to a catastrophic failure of prison care. Medical records, consultant evidence and multi-disciplinary meeting minutes supported the hospital's assessment that the claimant's needs could be met in the prison once an appropriate care package and staff training were in place. Article 2 was therefore unarguable because there was no real and immediate risk of death in prison or on proposed return. Article 3 and Article 8 claims were also unarguable; the incidents and conditions relied upon fell far short of the intense suffering or severe degradation required. The Equality Act claim lacked sufficient evidential foundation and was refused; the court additionally exercised its discretion to refuse any declaratory relief. The court discharged the interim restraining order (although the claimant was ultimately to be discharged to his home pursuant to an associated appellate outcome).

Permission to proceed was refused; the court held the Article 2 claim was unarguable because there was no evidential basis of a real and immediate risk to life from the prison detention and the acute deterioration was explained by thyrotoxicosis related to prior medication. Article 3 and Article 8 claims were unarguable because the treatment and conditions fell well below the high minimum level of severity required. The Equality Act 2010 claim under section 19 was refused for lack of sufficient evidence of failure to take reasonable steps. The court also discharged the interim order restraining discharge, the hospital's clinical decision having been a proper exercise of clinical judgment.