The psychiatrist had been engaged by W’s solicitors to examine him and prepare a report to go to the Tribunal hearing an application for the transfer or conditional discharge of W from a secure unit. His report was damning. W withdrew the application. Knowing of the serious differences of opinion between those who had seen W, E sought the solicitors permission to disclose the report to the secure hospital holding W. That consent was not given, but E forwarded a copy anyway.
Held: A psychiatrist instructed on behalf of a detainee in a secure hospital to carry out an examination of him was entitled in the exercise of a public duty to disclose to the authorities responsible for his future management the results of his assessment (which were indicative of the detainee presenting a continuing danger) and that any duty of confidence was subordinate to that. The public interest in the circumstances outweighed the doctor’s duty of confidence to the plaintiff. The nature of a hearing before a Mental Health Review Tribunal is inquisitorial, not adversarial.
Scott J described the circumstances of the conviction: ‘About ten years ago W shot the four members of a neighbouring family. He shot another neighbour who had come to investigate the shooting. He then drove off in his car, throwing hand-made bombs as he did so. Later the same day he shot two more people, not neighbours, but strangers to him. Five of his victims died of their injuries. The other two needed major surgery for serious bullet wounds. W was diagnosed as suffering from paranoid schizophrenia. It was believed by the doctors who examined him that he had been suffering from this illness for about two years before the offences. The illness involved delusions that he was being persecuted by his neighbours. In the circumstances W’s plea of guilty to manslaughter on the grounds of diminished responsibility was accepted by the Crown and he was convicted accordingly. Orders were made under sections 60 and 65 of the Mental Health Act 1959, now sections 37 and 41 of the Mental Health Act 1983, providing for his detention without limit of time. He was at first detained at Broadmoor Hospital. In 1981 he was transferred, in accordance with a transfer direction given by the Home Secretary, to a secure hospital in the North of England. Reference hereafter in this judgment to ‘the Hospital’ will be references to this hospital where W is still detained.’
 1 All ER 1089, 1989] 2 WLR 689
England and Wales
Cited – X v Y 1987
Complaint was made that defendant newspapers were to publish confidential medical records of doctors suffering Aids. An injunction was sought to prevent use of records given to a journalist by a hospital employee. The records related to doctors in . .
Appeal from – W v Egdell CA 1990
The plaintiff was detained in a secure mental hospital, under a hospital order coupled with a restriction order, after pleading guilty to manslaughter on the grounds of diminished responsibility. The defendant, a consultant psychiatrist, was engaged . .
Appeal from – W v Egdell CA 9-Nov-1989
The plaintiff had been confined to a mental hospital after killing several people by shooting. He complained that when he was to be considered for release, his psychiatrist, the defendant had broken his duty of confidence by revealing his concerns . .
Lists of cited by and citing cases may be incomplete.
Updated: 28 July 2021; Ref: scu.238534