X v Croydon Health Authority
High Court Queens Bench Division

Factual Background
The Claimant sued by her mother and litigation friend in respect of negligent administration of an anti-depressant in 1992. She had been admitted in June 1992 aged 18 after she was found unconscious at her home having expressed a desire to take an overdose the previous evening. She was discharged on 1st July 1992 and the discharge summary recorded "drug overdose" as a potential diagnosis.
Over the next five months she attended the Defendant's psychiatric outpatient department where she was reviewed at regular intervals and was prescribed anti-depressant medication.

Between the time of her discharge on 1st July 1992 and her appointment on 11th December 1992 the Claimant attended the psychiatric outpatient department regularly and complained of a variety of depressive symptoms.
On each occasion she was accompanied by her mother who was invited into the consultation and to whom any prescription would be given. The mother's account was that in view of the earlier apparent overdose there was a rigorously enforced system of filling the prescription and administering it to the Claimant such that she could not obtain control of any significant quantity herself.

On 11th December 1992 the Claimant attended an appointment with her father. There had been an argument at the previous appointment between the Claimant's mother and Dr Allsopp the psychiatric SHO with the result that the mother refused to attend.

Dr Allsopp saw the Claimant's father sitting outside but did not invite him into the room during the consultation. At the appointment Dr Allsopp was asked by the Claimant for a two month supply of the anti-depressant so as to tide her over the Christmas period.

The drug concerned was Doxepin (Sinequan) which can be fatal in even relatively small levels of overdose. The Claimant was given the prescription directly. On leaving the consultation Dr Allsopp failed to make any mention of the prescription to the Claimant's father. He subsequently asked the Claimant whether she had been given a prescription and she lied, indicating that she had not.
The Claimant made her own way home and on the way passed by a chemist where she filled the prescription. She was found a matter of hours later fitting on the floor of her bedroom in a coma.

Negligence
The claim was issued in December 1995 and advanced on the various grounds that:
(1) no proper psychiatric assessment had been carried out by Dr Allsopp before giving the prescription;
(2) any proper psychiatric assessment would have concluded that it was not appropriate to give the Claimant directly any prescription at all;
(3) there had been no attempt to inform the Claimant's father of the fact of the prescription so that supervision and monitoring could take place.

Admission
The Defendant admitted a "technical breach of duty" in the prescription of the Doxpin but denied damage and causation.

Condition
She was extremely ill, in respiratory arrest with cardiac arrhythmia. She was close to death. Her central nervous system was damaged. On recovery of consciousness her short term memory was noted to be impaired. That damage to her memory persisted such that she could not properly be left on her own to look after herself. Typically she would forget her keys, lose money and not recall that she had turned cookers and taps on. She could not remember even minor details for any length of time.

Prognosis
Assessing her prognosis was complicated by the admitted fact that she was severely depressed at the time of the overdose. The Claimant's case was in two stages: (a) but for the negligence her depression would probably have lifted by the time she reached her mid-twenties; (b) the organic brain damage suffered in consequence of the negligence had greatly complicated and delayed her recovery from depression; (c) nevertheless by the time of settlement (June 2000) she was recovering from depression and the remaining symptoms were consistent with brain damage.
The Defendant's case was that there was no organic brain damage and that the Claimant's poor level of functioning was consequent upon her overlying depression. The claim was complicated by the fact that after the second overdose the Claimant had obtained and maintained employment with different employers over a period of several years.Whilst it was admitted that there was a possibility that the neurological insult of the overdose could result in organic brain damage the Defendant denied that the Claimant could in this case prove that such damage had occurred.

Settlement
The Defendants' first offer was some 26 days before trial and for £950,000.00 this was rejected and increased to £1,050,000.00 this was rejected also. Shortly before trial the case was settled by a payment of £1,200,000. The substantial part of the settlement was paid on account of the significant future costs of care and loss of earnings. The Claimant was never likely to be able to look after herself and would only ever be able to work in a supported environment. Whilst it had never been suggested that she would have been a high-flyer the claim was advanced on the basis that up until her mid-twenties when her depression lifted she would have worked on a steadily increasing and regular basis as a secretary or receptionist. Thereafter she would have been able to continue earning full-time in a similar occupation until retirement. The case was approved by the Trial Judge and the Court of Protection.

Damages £1,200,000.00
Kieran Coonan QC and Michael Mylonas for the Claimant
Instructed by: Colum J Smith of McMillan Williams, Croydon New Addington branch