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England and Wales High Court (Queen's Bench Division) Decisions
You are here: BAILII >> Databases >> England and Wales High Court (Queen's Bench Division) Decisions >> Watling v The Chief Constable of Suffolk Constabulary & Anor  EWHC 2342 (QB) (02 August 2019)
Cite as:  EWHC 2342 (QB)
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QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL
B e f o r e :
| WAYNE WATLING
|- and -
|THE CHIEF CONSTABLE OF SUFFOLK CONSTABULARY (1)
G4S HEALTH SERVICES (UK) LTD (2)
Mr Adam Clemens (instructed by Weightmans) for the First Defendant
Mr Gurion Taussig (instructed by G4S Legal Department) for the Second Defendant
Hearing dates: 25th, 26th, 27th, 28th February 2019. 1st, 4th March 2019. 24th and 25th June 2019
Crown Copyright ©
His Honour Judge Saggerson:
1.Everyone has the right to respect for his private and family life, his home and his correspondence.
2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.
At The Police Investigation Centre ("PIC")
PC: "We need a doctor don't we"
Gemma: "If it's down to drugs then Yes"
PC: "He's not verbally engaging whatsoever … we still … need to follow it up with an unfit assessment…"
Gemma: "…absolutely yea … any health conditions that we are aware of?"
PC: "He won't engage verbally"
Gemma: "…the he's not known to you, you don't recognise him or anything?"
PC: "…we know who he is …"
Gemma: "Ah fine, so nothing that's … been (brought) up"
Gemma: "Right OK … my colleague just got Dr. Klotins on route, he's travelling from …quite far away." [The doctor is likely to exceed the one hour target].
At 4.32am it is likely that it was PS Ramsey ("Mark") who called the G4S call handler (although he does not remember it) asking for an estimated time of arrival for the medic attending for the claimant's section 4 tests. The operator could not reach the doctor and promised to call back as soon as she got hold of him. There was no call back. At 4.49am PS Ramsey tries again (and again he does not recall making contact). This time he was informed that the doctor was about 15 or 20 minutes away. By the time Sergeant Holly Branch called G4S from Martlesham to complain about delays later that morning, there were 5 other detainees waiting for an HCP at the PIC.
Dr. Klotins (the FME).
Conclusions from the roadside and PIC
Guidance for the Care of Detainees
46.1 Detainees requiring urgent medical attention should not be taken to a police station. Detainees suspected of swallowing unknown quantities of drugs should be taken to hospital immediately.
46.2 All detainees believed to be under the influence of drugs should be medically assessed by a healthcare professional. An HCP should also be consulted where any detainee is assessed as requiring constant observation.
46.3 Particular symptoms and behaviours are identified as demanding particular attention; including any problems understanding or speaking.
46.4 A detainee's unwillingness or inability to participate in a risk assessment should be seen as an additional risk factor.
The G4S System
"Call requests are prioritised in order of the patient's clinical need – first and foremost we ensure that the service being delivered is safe. In order to establish a patient's clinical need an initial triage will be undertaken by the call manager [handler]. This will identify the reason for the request including any acute conditions which need addressing …. Where the call manager feels there is a danger to the patient the call will be transferred to a Doctor for immediate advice".
Such a conclusion is most likely given Mr. Scott's personal experience of monitoring many calls. He knows that flashcards of some sort were in use in May 2014. He is not aware of any others. The likelihood is that they were the ones exhibited.
G4S – A Public Authority
The Claimant's Claims in Context
72.1 The contractual arrangements with G4S made no proper provision for prioritising calls, response times or recommendations for alternative means of treatment such as hospitalisation (triage concerns).
72.2 The arrangements with G4S made no proper provision for ensuring that relevant information was obtained by G4S call handlers about a detainee's current condition. In particular a clinician should have been available to take calls, or at least to be readily available to call handlers in potentially urgent cases with an appropriate protocol on which call handlers were trained to identify such urgent cases (enquiries concerns).
72.3 The contract with G4S permitted a geographical area for doctors (Essex and Norfolk) which created an obvious risk that the response time of 1 hour would be missed due to the distances it could reasonably be anticipated a doctor could have to travel (geographical concerns).
80.1 The claimant was exhibiting extensive symptoms (of stroke) at the roadside and at the PIC.
80.2 The unlikelihood that the claimant had taken drugs due to his personal profile (his age in particular) and the fact that his condition did not visibly improve whilst he was detained.
80.3 No proper account was taken of any possible alternative cause for the claimant's symptoms, especially in the light of what should have been known about the symptoms of a stroke from published Guidance on stroke and on summoning medical assessment for detainees.
80.4 The contractual target response time for medical assessment agreed with G4S had failed with regard to a call for a HCP for another detainee earlier on the same shift. An FME was unlikely to be available within the target timeframe of 1 hour from receipt of a request and as time passed during the night the increasing unlikelihood of timely medical assistance arriving increased.
87.1 There was no requirement for the call-handler (Gemma) to probe further behind the information she was given by PC Last at 3.04am or to make further enquiries.
87.2 No particular investigatory protocol was required in the absence of any expressed concern by the police as to the claimant's medical presentation as described in the first call.
87.3 The system that was in place was adequate and it was for the relevant custody officer to escalate the call to a doctor or transfer the claimant to hospital.
87.4 Whilst the delay in the arrival of an FME would be of potential significance for the purposes of a non-urgent section 4 sample, given the information provided to G4S by the police, no emergency was apparent.
87.5 If G4S did not have constructive knowledge of a medical emergency (which they did not) and had an adequate system for processing non-urgent call-outs the geographical area covered by the FME is relevant only to the viability of the section 4 sample.
Causation - The Neurologists
103.1 They estimate the onset of the stroke at approximately 2.25am.
103.2 They agree that it would be usual to offer thrombolytic treatment up to 4.5 hours after the onset of the stroke. That would be up to 6.55am in the present case.
103.3 It is agreed that the dominant factor determining outcome of thrombolysis is "the time to needle", that is the time at which thrombolytic treatment commences which will not be the same as the time a patient arrives at a hospital.
103.4 Statistically, the commencement of treatment between 1½ and 3 hours after onset of the stroke carries an 11% chance of an improved outcome as against no such treatment. Commencing treatment between 3 and 4½ hours after the onset of the stroke carries a 6.7% chance of an improved outcome. There was nothing in the claimant's profile or presentation to suggest he fell outside this statistical pattern which takes into account the risk of an adverse outcome such as an intracranial bleed.
103.5 They agree that other factors affect the outcome such as the size and location of the clot and the presence or absence of collateral circulation.
103.6 It is agreed that MR scanning and a CT angiogram ("CTA") on 18 May 2019 showed an occlusion of the internal carotid artery in the neck.
103.7 The timing of the CTA is not known. They agree that between the onset of the stroke and the CTA there would have been a process of organisation of the clot and this would have reduced the effectiveness of treatment.
103.8 They agree that had the CTA been undertaken during the 4½ hour therapeutic window and shown the same occlusion as was later shown this would have suggested a poorer outcome than is statistically indicated, but to a degree that is unknown.
103.9 They agree that the administration of thrombolysis would have carried with it "some possibility" of a better outcome, but the possibility would at all times have been small. As a matter of probability, they agree, the time of the claimant's arrival at hospital would have made no difference.
24 July 2019