Baker & Ors v Cambridgeshire And Peterborough NHS Foundation Trust

The standard of care for a psychiatrist is that of a reasonably competent psychiatrist exercising reasonable care and skill at the relevant time. A doctor is not in breach merely because another reasonable clinician might have taken a different course. Causation ordinarily requires proof that, but for the alleged negligence, the injury would probably have occurred. The material-contribution approach does not replace the but for test where the evidence permits the court to determine whether the alleged act was causative. A secondary-victim claim is subject to the established control measures, including sufficient proximity in time and space to the event causing the claimant’s psychiatric injury.

The claim arose from the suicide of Philip Baker after he had been assessed twice by a psychiatrist employed by the defendant NHS trust. His widow brought claims under the Fatal Accidents Acts 1976 and the estate claimed under the Law Reform (Miscellaneous Provisions) Act 1934. His son and stepdaughter claimed psychiatric injury after seeing his body.

The issues were whether the psychiatrist had acted negligently by failing to involve community mental health services after the first consultation or by discharging Mr Baker after the second, whether either alleged breach caused his death, and whether the stepdaughter qualified as a secondary victim.

1. Breach of duty. The applicable standard was that of a reasonably competent psychiatrist exercising reasonable care and skill, applying the approach in Bolam v Friern Hospital Management [1957] 2 All ER 118, approved in Maynard v West Midlands Regional Health Authority [1985] 1 All ER 63. The psychiatrist’s assessment on 29 September 2010 was competent. The available risk factors did not require involvement of community mental health services. Her decision to arrange a further consultation and a carer’s assessment was reasonable.
2. The decision on 26 October 2010 to discharge Mr Baker to his general practitioner was also within the range of acceptable clinical practice. There was no evidence of immediate suicidal ideation or risk requiring hospital admission, crisis-team involvement or continued specialist care.
3. Causation. The claimants had not established that either alleged breach caused the suicide. The evidence did not show, on the balance of probabilities, that earlier community involvement or another outpatient appointment would have prevented it. The but for test remained applicable. The late reliance on material contribution, based on Bailey v Ministry of Defence [2008] EWCA Civ 883, added nothing because this was not a case in which medical science prevented determination of the probability that the injury would otherwise have occurred.
4. Secondary victim. The stepdaughter’s claim was rejected on the facts. Had it been necessary to decide the legal issue, the court would have held that seeing the body approximately 45 minutes after the death lacked sufficient physical proximity in time and space, applying Taylor v A Novo (UK) Ltd [2013] EWCA Civ 194.
5. Judgment was entered for the defendant. Any consequential orders were to be agreed or, failing agreement, determined on relisting.