Prison Medical Care and Status Epilepticus

Abstract

The case of Ryan St George v Home Office [2008] EWCA Civ 1068 raised unusual issues on breach of duty, causation and contributory negligence. The 29 year old claimant had a history of alcohol and drug abuse, withdrawal seizures, and previous custodial sentences. Five days after his admission to Prison he sustained a substance withdrawal seizure injury, falling from the top bunk and striking his head on a concrete floor. He developed status epilepticus and subsequent irreversible brain damage. The medical case on causation was whether the head injury resulting from the fall triggered status epilepticus or whether the status epilepticus was a consequence of the withdrawal seizure alone. Mackay J held that the head injury triggered the status epilepticus and that the Home Office had acted in breach of duty following the claimant's admission to prison when he was allocated a top bunk in a dormitory wing. A novel issue on contributory negligence arose because Mackay J reduced the claimant's damages by 15% because his injuries were caused partly by his substance abuse, therefore his “fault” within the meaning of section 1(1) of the Law Reform (Contributory Negligence) Act 1945 (“the 1945 Act”). There had been no previous direct authority on this point. The judge's findings were the subject of an appeal to the Court of Appeal where in the leading judgment Dyson LJ dismissed the appeal against the findings on breach of duty and causation and allowed the cross-appeal against the finding of contributory negligence.