X NHS Foundation Trust vs RH

This case concerned the capacity and best interests of RH, a 40-year-old man with hebephrenic schizophrenia, requiring urgent urological surgery.

TLDR:

• RH, a 40-year-old man, was detained under the Mental Health Act 1983.
• RH required urgent urological surgery due to declining kidney function.
• The court had to determine RH's capacity and best interests regarding the surgery.
• The court found that RH lacked capacity and that the surgery was in his best interests.
• Physical and chemical restraint were authorized to facilitate the surgery.

RH, a 40-year-old man detained under section 3 of the Mental Health Act 1983, suffered from hebephrenic schizophrenia and severe bilateral hydronephrosis. The X NHS Foundation Trust applied for declarations and orders under the Mental Capacity Act 2005, asserting that RH lacked capacity to make decisions about his inpatient admission and urological surgery.

The Trust sought authorization for RH's admission to an acute hospital for surgery, the use of physical and chemical restraint, and the deprivation of liberty as necessary for the treatment. RH's mother, although not a party, supported the Trust's application and provided valuable insights into RH's condition.

The procedural history of the case was marked by delays and a haphazard presentation of evidence by the Trust. Despite these issues, the court proceeded with the hearing, considering the evidence provided by the Trust's medical professionals and the Official Solicitor.

Dr. L, RH's treating consultant forensic psychiatrist, provided clear evidence that RH's schizophrenia and persistent delusions rendered him unable to understand or weigh the relevant information regarding his treatment. RH believed that the proposed surgery was an attempt to remove his kidneys, a delusion that significantly impacted his capacity to make decisions.

Mr. S, the consultant urological surgeon, outlined the risks and benefits of the proposed surgery, emphasizing the potential to prevent kidney failure and improve RH's life expectancy. The court found that the benefits of the surgery outweighed the risks and discomfort associated with the procedure.

Dr. A, the consultant anaesthetist, detailed the sedation and restraint measures that would be used to manage RH's agitation and ensure his safety during the procedure. Ms. C, a mental health nurse familiar with RH, described the stepped approach to restraint and the support RH would receive from trained staff.

The court concluded that RH lacked capacity to make decisions regarding his treatment and that the proposed surgery was in his best interests. The use of physical and chemical restraint was deemed necessary and proportionate to ensure the safe delivery of the treatment.

The court emphasized the importance of considering RH's welfare in the widest sense, including his medical, social, and psychological needs. The views of RH's mother were also taken into account, and she was actively involved in supporting RH throughout his hospital admission and recovery.

In conclusion, the court granted the Trust's application, authorizing the proposed surgery and the use of restraint as necessary. The matter was directed to return to court if no obstruction was found during the surgery, ensuring that RH's best interests would continue to be safeguarded.

Legal representatives: Mr. Vikram Sachdeva KC (instructed by Kennedys) for the Applicant, Mr. James Berry (instructed by the Official Solicitor, as litigation friend) for the Respondent

Judicial Panel: Miss Nageena Khalique KC sitting as a Deputy High Court Judge and a nominated Judge of the Court of Protection

Case Citation Reference: [2024] EWCOP 150