1180

but we can’t keep up with the demand." Trent Region’sadmission figures support this case. In 1974 Trent treated31 229 orthopaedic cases; in 1975 they treated 32 176; foreach subsequent year the figures have been: 33 735; 34 592;35 697; 34 031.Dr Richards sees no need for the Government to rely on

statistics which seem to him "a bit bogus". They would havedone better "to quote the number of admissions as tell peoplethe service is getting better and better," he says. "We tend tobe rather secretive and defensive in the N.H.S. Whensomeone attacks the waiting lists we try to defend them on anarrow front instead of explaining why they might not be sobad after all."

The Mental Health Bill

THE Government’s proposed reforms in the status of

compulsorily detained mental patients are to be used by theLabour Opposition as an opportunity to press for widerchanges affecting all mental patients. The Social ServicesSecretary, Mr Norman Fowler, hoped his Mental Health Billamending the 1959 Mental Health Act would prove non-controversial. His proposals are acceptable to Oppositionspokesman, Mrs Gwyneth Dunwoody, as far as they go. MrFowler plans to set up a Mental Health Commission,consisting of 70 members (doctors, nurses, psychologists,lawyers, social workers, and lay people) operating in regionalpanels. Their job will be to check the correctness of the waycompulsory admission procedure is applied, visitingregularly hospitals where patients are compulsorily detained.They will listen to patients’ complaints, and check on recordsand on staff. They will also draw up a code of practice, listingtreatments which should not be given without patients’consent, or consent from a second opinion in the shape of anindependent doctor chosen by the Commission. TheCommission will also list treatments to be used only withextreme caution. Treatments the Commission will have to

categorise include electroconvulsion therapy, brain surgerysuch as leucotomy, and courses of powerful psychotropicdrugs. Mr Fowler will choose the Commission’s members.Mr Fowler also intends to allow detained patients twice as

frequent access as at present to the Mental Health ReviewTribunals, and to double the frequency of reviews of individ-ual cases. More than 7000 patients are affected by thesechanges. The D.H.S.S. expects the number of Tribunal hear-ings to rise from 904 in 1980 to 4500 a year. Although themeasure will be law by the end of next summer, administra-tive problems will delay its full implementation until theautumn of 1983. But the D.H.S.S. intends to increase the

frequency of reviews, by administrative action, as soon as theBill is law.The plan is to sweep away the 1959 restriction that

prevents mentally handicapped or psychopathic people over21 years old being compulsorily detained. Instead

prospective compulsory patients will be subject to a test oftreatability, administered by a psychiatrist nominated by theMental Health Commission. If the patient is deemedtreatable he may be detained. The Government hopes thischange will further reduce the numbers compulsorilydetained. The psychiatrist named by the Commission willalso have the power to compel treatment when a patient isconsidered capable of giving consent but is unwilling to do so,or is unable to understand what is involved in giving consent.But Mrs Dunwoody says the measure does not deal with

enough aspects of the mental hospital system. She wantsmore consideration of secure units and the way they are run;more thought about the position on non-detained patients;consideration of the best way to deal with juvenile offenders

who need treatment. "This Bill is only being introduced,"she says, "because of the judgments of the European Court ofHuman Rights, which has severely criticised Britain... Butit is a very limited Bill. A lot of people don’t believe the newarrangements will be an improvement."

RODNEY DEITCH

Medicine and the Law

Damages for Personal Injuries Payableto Young Child

AT the time of assessment, the plaintiff was a child agedunder 5. He had been normal and healthy when born on July 24,1976, at University College Hospital, London. When he was afew days old he had persistent vomiting and was readmitted to thehospital. 6 days later, when 17 days old, he was given a seriousoverdose of anaesthetic in preparation for an operation to cure thevomiting. The consequences of the overdose were tragic and ter.rible. He was now a very severely abnormal child with a mentalage of between 15 and 18 months. He was subject to epilepsy andhad had four or five attacks already and one of those had lasted for1’/z hours. He would be unable to earn a living and not be in aposition to marry. He needed constant care and attention, which hisparents, who were unusually devoted, were willing to give him; hewas the middle of five children under 10. Though he had walkedsince he was 2, he was bandy-legged, could not walk far, andstumbled and fell, frequently hurting himself. He was doublyincontinent by day and by night, could speak only a few words, hadlittle sustained attention, could not feed himself, and slobbered. Hecould be aggressive to the other children and had to be fully assistedwith washing and dressing. He was hyperactive, obstructive, anddestructive and had to be supervised all the time. He had a squintattributable to the brain damage inflicted by the excessive

anaesthetic, and he woke frequently during the night and with himthe whole family at 5.30 a.m. His parents were worthy ofthe highestpraise; he slept in their bedroom and the only peace they had was intermtime when he attended a special school for handicappedchildren. He was also liable to colds and coughs and ear infections.He was, however, very affectionate and friendly towards his parentsand those he knew. His feelings ran to an understanding of theaffection and disapproval shown him. He would appreciate moreand more as time went on that other children were different fromhim and able to do things he could not. He was likely to experiencedeep unhappiness and frustration and to worry about hisincontinence of faeces and urine and to have an awareness of his

plight. His total life span had been shortened to an estimated 271f2years.The Area Health Authority admitted liability for negligence, but

disputed the amount of damages. Mr Justice Comyn awardeddamages under the following heads:1. Pain and suffering and loss of amenities 50 0002. Cost of future care and attention 156 0003. Loss of earnings 75004. Agreed special damages 56675. Loss of earnings during lost years nil

Total 220 007+ interest

Under head 5, it was held that a young child could claim damagesunder the head of loss of earnings during lost years and that such aclaim was not limited to exceptional cases where the child wasalready earning at the time of the accident, such as a child televisionstar. Accordingly, the plaintiff was qualified to claim under thathead of damage, but on the material before the court the claim wouldbe assessed as nil. Pickett v British Rail Engineering Ltd (1979) 1 AllER 774 and Gammell v Wilson (1981) 1 All ER 578 wereconsidered.

Connolly v Camden and Islington Area Health Authority. Comyn J. April 8.1981. Reported in (1981) 3 All ER 250.

DIANA BRAHAMSBarrtster-at-Law