L, In re

LORD GOFF OF CHIEVELEY

My Lords,

      The respondent, Mr. L, is 48 years old. He is autistic, and is profoundly mentally retarded. He is unable to speak, and his level of understanding is severely limited. It follows that he has always been incapable of consenting to medical treatment. He is frequently agitated; he has no sense of danger, and has a history of self-harming behaviour.

      From the age of 13, for a period of over 30 years, he was a resident at the Bournewood Hospital, which is now run by the appellant NHS Trust. In March 1994, however, he was discharged on a trial basis into the community. He went to live with paid carers, Mr. and Mrs. E.; but since he had not been finally discharged, the appellant Trust remained responsible for his care and treatment. Mr. and Mrs. E. became very fond of him and, with their children, regarded him as one of the family.

      On 22 July 1997, at the Cranstock Day Centre which was regularly attended by him, Mr. L became particularly agitated, hitting himself on the head with his fists and banging his head against a wall. Mr. and Mrs. E. could not be contacted. The Day Centre got in touch with a local doctor, who attended and administered a sedative. The social worker who had overall responsibility for him was also contacted. She attended and, on her recommendation, he was taken by ambulance to the Accident and Emergency Department at the Bournewood Hospital. As a result of the sedative given to him, he became calm and relaxed; but while at the Department he became increasingly agitated. He was assessed by a psychiatrist as being in need of in-patient treatment. He made no attempt to leave, and was transferred to the behavioural unit at the Hospital. His consultant, Dr. Manjubhashini, decided that his best interests required that he should be readmitted for in-patient treatment. She considered whether it was necessary to detain him under the provisions of the Mental Health Act 1983 but decided that this was not necessary because he appeared to be fully compliant and did not resist admission. I shall have to refer to her evidence in more detail at a later stage. He was therefore admitted informally.

      The doctors and staff at the Hospital responsible for treating Mr. L regarded it as very important for his future that he should be returned to live with Mr. and Mrs. E. as soon as practical. But Mr. and Mrs. E. have unfortunately not been satisfied as to the Trust's motives. Dr. Manjubhashini wrote to Mr. and Mrs. E. explaining what was proposed, discussing meetings and visits by Mr. and Mrs E. to see Mr. L, but no programme of visits…