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St George v The Home Office, Court of Appeal, 8 October 2008

3 November 2008
The issues

Contributory negligence – drugs abuser – prisoner – causation – liability to Home Office to prisoner who was a drug abuser and who fell from a bunk.

The facts

A Claimant, who was 29, was sent to Brixton prison in October 1997 to serve a 4 month sentence for theft. He had abused alcohol and drugs since 16 and was an intravenous heroine user. He told the prison authorities this and that he drank heavily and had previously had withdrawal seizures. He refused to see a doctor and was allocated to “an ordinary location”. The health screen interview confirmed that he had fits, that he was currently using intravenous heroine and valium, and that he drank 5 or 6 pints of alcohol a day. He was sent to ward 3 of the hospital wing of the prison, which was then being used as an ordinary unit for the accommodation of category D prisoners. It was an open dormitory with some single beds and some bunk beds. The prison officers decided who slept in which bed and inmates were not allowed to switch beds or bunks at will. The Claimant slept on a top bunk and at about 6pm on the 3rd November 1997 he had a seizure, resulting from his withdrawal from alcohol and drugs and causing him to fall from his top bunk, 7 or 8 feet, to the floor. He suffered a head wound. He was attended by nurses in the prison at about 6.10pm and an ambulance crew just before 7pm and taken to King’s College Hospital, where he arrived at 7.25pm. His fitting was brought under control at 7.45pm but scanning over the following days revealed progressive severe damage to the brain and which left the Claimant severely and permanently disabled, after global hypoxic ischaemic damage. The matter came before the Trial Judge on a preliminary issue as to whether the Home Office was liable to the Claimant and, if so, whether or not any of the injuries pleaded were caused by any negligence on the part of the Home Office.

The Trial Judge found the Home Office negligent for allocating the Claimant to a top bunk when prison staff knew that he had a history of substance abuse and withdrawal seizure, not protecting his airway from obstruction between the time of his fall and the arrival of the ambulance crew and not administering oxygen to him during that time, and being responsible for various matters combining to delay the Claimant’s arrival in hospital until 7.25pm. The Judge found however that the delay did not contribute to his brain damage. On causation the Judge found that the head injury had caused the withdrawal seizure to develop into status and that the hypoxic ischaemia had been caused by airway obstruction and / or the failure to administer oxygen before the arrival of the ambulance. The Judge further found that, but for these breaches, the Claimant would have made what would have amounted to a full recovery. He found contributory negligence on the part of the Claimant in terms of his addiction to Benzodiazepine and alcohol, which was the result of his own lifestyle decisions and assessed it at 15%.

The Defendant appealed on causation and liability, liability in respect of the breach of duty in not protecting the Claimant’s airway. There was no appeal in respect of the negligent allocation of the Claimant to a top bunk.

The decision

The challenge to the Judge’s finding on causation was a challenge to his findings of fact. It was not a challenge based on a mis-direction or a challenge based on lack of reasons. The Judge preferred the evidence on one expert to that of another. Such a challenge should only be upheld if the Court of Appeal were satisfied that the Judge’s conclusions were clearly wrong. The Court was far from persuaded that the Judge was clearly wrong. He was entitled to prefer one expert. The medical literature showed that withdrawal seizures on their own did not result in status and that there must be another factor that, taken in conjunction with the withdrawal seizure, would lead to status.

Was the Judge right to reduce the Claimant’s damages by 15%?

The Judge was entitled to hold that the Claimant was at fault in becoming addicted to drugs and alcohol when he was 15 or 16 years of age and to infer that the Claimant must have known at that time that the abuse of drugs and alcohol on the scale necessary to lead to addition was dangerous to his health.

However, the Claimant’s fault in becoming addicted to drugs and alcohol was not a potent cause of the status and consequent brain injury which were triggered by his fall. It was too remote in time, place and circumstance, and was not sufficiently connected with the negligence of the prison staff to be properly regarded as a cause of the injury. It was no more than part of the history which had led to his being a person whose medical and psychological conditions were as they were when he was admitted to the prison.

If the Claimant’s injury had been partly the result of his fault in becoming addicted to drugs and alcohol as a teenager then the Court would not have regarded it as just and equitable to reduce his damages, having regard to his share in the responsibility for the injury. He had informed the prison staff when he arrived at the prison that he was an intravenous heroine user, that he drank heavily, and had previously had withdrawal seizures. The staff (rightly) did not permit him to take drugs or alcohol and therefore knew, or ought to have known, that he might suffer from seizures, and yet they placed him in a top bunk. His position was analogists to that of a patient admitted to a rehabilitation clinic for the express purpose of being weaned off his addiction to drugs.

His damages would not therefore be reduced. Appeal dismissed, cross appeal allowed.

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The content on this page is provided for the purposes of general interest and information. It contains only brief summaries of aspects of the subject matter and does not provide comprehensive statements of the law. It does not constitute legal advice and does not provide a substitute for it.

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