Daniel & Anor v St George's Healthcare NHS Trust & Anor

The operational duty under Article 2 may arise in relation to detainees where authorities know, or ought to know, of a real and immediate risk to life. It may apply to healthcare and ambulance authorities temporarily responsible for a detainee, and does not require a systemic failure. The relevant standard is reasonableness, assessed in the circumstances and without imposing an impossible or disproportionate burden. Convention causation is less demanding than ordinary tort causation: a reasonably available measure with a real prospect of altering the outcome, or a substantial chance of avoiding it, may suffice. Article 3 requires treatment attaining the requisite minimum level of severity. Indirect victim status under Article 34 depends on the whole relationship and the applicant’s personal effect, suffering and involvement in related proceedings.

James Best, a remand prisoner, died in HMP Wandsworth from a myocardial infarction and cardiac arrest after exercising. His foster mother and foster brother brought claims under the Human Rights Act 1998 against the NHS Trust providing prison healthcare and the London Ambulance Service. They alleged delay in calling and dispatching an ambulance, contrary to Articles 2 and 3 ECHR.

The issues were whether the Article 2 operational duty was engaged, the applicable causation test, whether either Defendant breached Article 2 or Article 3, and whether each Claimant was a victim entitled to bring proceedings.

1. Article 2 duty. The operational duty to protect life can arise in the care of detainees where the authorities knew or ought to have known of a real and immediate risk to life. It is not confined to systemic failures or protection from attack. The duty may extend to public authorities, including hospitals and ambulance services, which temporarily assume responsibility for a detainee. The governing standard is whether the authority did all that could reasonably be expected of it, having regard to the circumstances, the ease or difficulty of precautions and available resources, without imposing an impossible or disproportionate burden.
2. Conduct of the prison healthcare service. The nurse acted reasonably in treating the presenting symptoms as an asthma attack, applying the ABCDE approach, administering oxygen, monitoring the patient and reassessing his condition. It was reasonable to assess him before calling an ambulance. Once his oxygen saturation failed to improve and his condition deteriorated, she recognised the real and immediate risk to life and promptly called for assistance and an ambulance. There was no breach.
3. Ambulance service. The Medical Priority Dispatch System was a reasonable means of allocating a limited emergency resource. The call handler correctly triaged the information provided, consulted her manager when the response appeared inadequate, protected the dispatched ambulance from cancellation and upgraded the call when objective information indicated that the prisoner was gravely ill and suffering a heart attack. Any avoidable delay resulted from the failure to provide sufficient information, not from an unreasonable LAS response.
4. Causation. The Claimants had to show that a reasonably available measure could have had a real prospect of altering the outcome, or that the deceased lost a substantial chance of avoiding it. They failed to establish that an earlier ambulance or earlier paramedic attendance would have altered the result, since CPR and defibrillation were provided promptly by prison medical staff and earlier advanced treatment was unlikely to have affected the fatal outcome.
5. Articles 3 and victim status. The conduct complained of did not attain the minimum severity required by Article 3. The foster mother was just sufficiently connected to the deceased to qualify as an indirect victim, having had a long-standing parent-child relationship, suffered acute distress and actively pursued investigations. The foster brother was not an indirect victim: their close relationship and distress, without a recognised family or legal relationship, were insufficient.
6. Disposition. The claims against both Defendants were dismissed.

Not stated in the judgment.