Touche - Coroner Appeal Dismissed - Legal Summary
21/03/2001
May I thank you for the way my accident claim has been handled, after my accident my confidence was very low indeed but the sympathetic handling of my case restored my confidence.
John, Sheffield
Today a London Coroner's Appeal was dismissed by the Court of Appeal following his challenge of a High Court decision requiring him to hold an inquest into the death of Laura Touche.
Please find below details of the case, a legal summary and law report.
In June 2000 Alexander Harris acting on behalf of Mr Peter Touche successfully Judicially Reviewed the decision by the Coroner for the Inner North London District not to hold an inquest into the death of his wife Laura. The Coroner was of the view that Laura died of natural causes and therefore no inquest was held.
The Coroner appealed the High Court's decision on the grounds that he was entitled to decide that there was no reasonable cause to suspect that Laura Touche had died an unnatural death. He therefore didn't feel that it was necessary to hold an inquest. He also appealed on the ground that the original High Court decision would lead to an increase in inquests generally.
Grainne Barton, Partner at Alexander Harris and Mr Touche's Solicitor said: "This is a very important decision. We are pleased that the Court of Appeal has clarified this area of the law in relation to inquests. We hope that it will benefit families in the future especially as those who lose a loved one have to face the inquest system at a time when they are at their most vulnerable."
Grainne added: "APIL (Association of Personal Injury Lawyers) is also calling for radical modernisation of the Coroners system and simplification of the law. This case highlights this need and makes a significant contribution to the ongoing review."
Laura Touche aged 31, tragically died 15th February 1999 from a brain haemorrhage, after giving birth to twins by caesarean section at the private Portland Hospital For Women and Children in London. Following the operation Laura was not monitored for in excess of two hours when it was found that her blood pressure was elevated. Laura's condition deteriorated and a brain scan confirmed that Laura had suffered a brain haemorrhage.
Peter Touche said today: "I am delighted that the Court Of Appeal has reaffirmed the decision of the High Court. I hope that this will help other people find the answers they deserve. I owe it to my wife Laura and our two sons to understand the facts of what happened."
LEGAL SUMMARY
Please find below a legal summary prepared by Alexander Harris following the Court of Appeal decision today (21st March 2001) in the case of The Queen and HM Coroner for Inner North London District ex parte Peter Touche.
Today's Judgment makes the following points:-
1. Where a death takes place in hospital and a failure to provide "routine" treatment is a cause (even a secondary cause) of death, the Coroner, for the purpose of deciding whether or not an inquest ought to be held, should conclude that the death may be unnatural, and that an inquest ought therefore to be held. The combination of the unexpectedness of the death and the culpable human failing are the factors which result in the death being considered as potentially unnatural within the meaning of section 8 of the Coroners Act 1988. The death, in those circumstances "should never have happened" (Simon Brown LJ); it is "abnormal and unexpected" (Robert Walker LJ). Note that this is so even in cases where the culpable failure falls short of "neglect" in the Jamieson sense.
This is a relatively new law. Previously Coroners may have thought (and the Coroner in this case argued that they did think) that they had to look for a single dominant cause of death. If that was natural, then, whatever other causes may have been present, the case would have been classified as natural, and no inquest held.
On this simple basis, the Coroner ought to have concluded in the present case that an inquest ought to be held, and, since there has now been a cremation, he will report the facts to the Secretary of State who may order an inquest - the court indicated its view that, on the facts, an inquest is likely to be directed.
2. Even if the court had decided that this was not an unnatural death in that sense, it would have held that these facts had the potential to be a "neglect" case, where the evidence suggests that there may have been a gross failure to provide basic medical attention to a person in a dependent position, which may have caused or contributed to the death. Such cases, even before the present case, have been considered as unnatural for the purpose of deciding whether or not there should be an inquest (even where the ultimate verdict is likely to be death by natural causes contributed to by neglect).
3. Present facts indicate that the death probably occurred in circumstances the continuance or possible recurrence of which would be prejudicial to the health of a section of the public - jury therefore necessary.
4. The Coroner must pay the costs of this case - he fought and lost and appealed and lost and the usual rule, that the loser pays, applies. This is so even if the Coroner, as here, assists the court by appearing and arguing. This also is new. The previous rule appeared to be that where a Coroner did not adopt an adversarial position, but merely appeared in order to assist the court, he would not have to pay costs even if he lost.
The Times Law Report - Friday March 30 2001
CORONER TO HOLD INQUEST INTO HOSPITAL DEATH
COURT OF APPEAL
Regina (Touche) v Inner London North Coroner
Before Lord Justice Simon Brown, Lord Justice Robert Walker and Lord Justice Keene
Judgment March 21, 2001
Death resulting from inadequate monitoring of the deceased's blood pressure after she had given birth was an unnatural death for the purposes of section 8(1)(a) of the Coroners Act 1988.
The Court of Appeal so held in a reserved judgment, dismissing an appeal by the Inner London North Coroner, Dr Stephen M. T. Chan, from a decision of the Queen's Bench Divisional Court (Lord Justice Kennedy and Mr Justice Morison) on June 22, 2000 to grant an application by Peter Francis Touche for judicial review of the coroner's refusal to hold an inquest into the death of his wife, Mrs Laura Touche.
Mr Ian Burnett, QC, who did not appear below, and Mr Ben Collins for the coroner; Mr Philip Havers, QC and Mr Simon Taylor for Mr Touche.
LORD JUSTICE SIMON BROWN said that the deceased was delivered of healthy twins at about 10.25pm on February 6, 1999 by caesarean section under spinal anaesthetic at the Portland Hospital in London.
Following delivery her blood pressure was noted to be 120/60 which was within normal bounds, and at around 11pm she was transferred to the postnatal ward. She was complaining of headache.
The next note of her blood pressure was at 1.35am when it was recorded to be 190/100. By then her headache was severe and she was clearly unwell.
Only at that stage did treatment begin and her blood pressure start to be taken regularly until finally it fell to normal limits. By then, however, it was too late.
At 5.15am she was suffering a left-sided hemiplegia. At 6.15am she was transferred to the Middlesex Hospital and from there to the National Hospital for Neurology and Neurosurgery at Queen Square where eight days later, on February 15, she died.
His Lordship reviewed the remainder of the evidence and said that the evidence as a whole provided clear grounds for suspecting that the Portland Hospital failed to monitor the deceased's blood pressure as it should have done in the critical post-operative phase and that such failure was an effective cause of her death in that, but for it, she would probably, or at least possibly, not have suffered cerebral haemorrhage and died.
The central question to address was whether in the light of the facts there was reasonable cause to suspect that Mrs Touche died an unnatural death.
In the ordinary way, it was for the coroner to decide whether there was reasonable cause to suspect that a particular death was unnatural, and his decision would not be challengeable unless it was Wednesbury unreasonable ((1948) 1 KB 223) or involved a self-misdirection in law.
The facts in the present case having now substantially crystallised, however, the point had been reached where really there could only be one correct answer to the central question and that answer depended on what was meant in section 8(1) by "unnatural death".
In its judgment the Divisional Court said: "Where, as in this case, a patient is in hospital suffering from a condition which if not monitored and treated in a routine way will result in death, and, for whatever reason, monitoring and treatment is omitted, then ... the coroner must hold an inquest unless he can say that there are no grounds for suspecting that the omission was an effective cause of death ... In dealing with the statutory test omission can be as important as commission, and that
... is what ... the coroner failed properly to recognise and evaluate." Mr Havers submitted that the judgment of the Divisional Court was correct for the reasons they gave.
Alternatively, he sought to uphold the decision on the narrower ground that it would be open to the coroner, or jury, in the present case to return a verdict that the death was caused or contributed to by neglect, in which event, as was common ground, there would certainly have to be an inquest.
The verdict which Mr Havers contemplated was that the deceased died from natural causes to which neglect contributed: see R v North Humberside Coroner, Ex parte Jamieson ((1995) QB 1, 25).
His Lordship found Mr Havers's argument on that part of the case compelling. Upon such material as was presently available to the coroner he could not properly decide otherwise than that there was reasonable cause to suspect that the deceased's death was (a) at least contributed to by neglect, as narrowly defined in Ex parte Jamieson and thus (b) unnatural, as would necessarily follow from R v Poplar Coroner, Ex parte Thomas ((1993) QB 610).
Assuming there was now to be an inquest, would it be held with a jury? It would seem difficult on the material presently available to regard the death as having occurred otherwise than "in circumstances the continuance or possible recurrence of which is prejudicial to the health ... of (a) section of the public" within the meaning of section 8(3)(d) of the 1988 Act.
The wider point which lay at the heart of the appeal was whether the Divisional Court was right to hold that whenever a death took place in hospital and a failure to provide routine treatment was a cause, even a secondary cause of death, the death was unnatural.
It was that holding which so concerned the coroner and, Mr Burnett said, other coroners too.
When deciding whether or not for section 8(1)(a) purposes a death was unnatural, one should be considering why Parliament had included that category of deaths among those into which an inquest had to be held.
What was it about unnatural deaths that called for an inquest? Was there not a powerful case for saying that an inquest should be held whenever a wholly unexpected death, albeit from natural causes, resulted from some culpable human failure, or, more strictly, whenever the coroner had reasonable grounds to suspect that such was the case? Such deaths prompted understandable public concern, and no small part of the coroner's function was to carry out an appropriate investigation to allay such concern.
His Lordship would have upheld the judgment below even had he not concluded that an inquest was in any event required because of the possibility of a neglect verdict.
Lord Justice Robert Walker and Lord Justice Keene delivered concurring judgments Solicitors: Hempsons of Manchester; Alexander Harris.
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