Car was `lethal weapon' for schizophrenic

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Clarification over the rights and duties of doctors to report seriously mentally ill patients to the driving licence authority is to be sought after a paranoid schizophrenic killed a young mother in a car in a London car park.

An inquiry published yesterday into the case of Nilesh Gadher, 37, a paranoid schizophrenic with a history of violence and of failing to take his medication, lists a catalogue of errors in his care. They culminated in him killing Sanita Kaura, 27, the mother of a young baby, when he struck her while driving at up to 45 mph in the car park. He was judged unfit to stand trial.

He had been in hospital four times since 1984 but was discharged to the community in March 1994 under a plan which the inquiry says was "doomed to fail" and "naive at best". A consultant psychiatrist misunderstood the law and did not know that Gadher could be detained because of fears over his mental health.

His condition deteriorated, he left a rehabilitation work project, he was not taking his medication and he set out to work as a mini-cab driver. But despite a warning six months before from his father and brother that he could kill himself or someone else, and despite complaints from neighbours over his behaviour and evident deterioration, a social worker decided Gadher did not meet the criteria for compulsory treatment.

But the inquiry said it was also concerned that Gadher was able to buy and drive a car, possibly with fare-paying passengers in it, while in his psychotic state. "The fact of the matter is that a car is every bit as lethal a weapon in the wrong hands at the wrong time as a firearm," the inquiry chaired by Judge Main said.

A patient admitted to hospital with a psychosis has a duty to inform the Driver and Vehicle Licensing Agency, which can revoke the licence, and should be advised by doctors not to drive. But there is nothing in law to prevent someone driving against advice the inquiry said, although it "may be appropriate" for the doctor to tell the DVLA.

Ealing, Hammersmith and Hounslow Health Authority, which with Ealing Council commissioned the report, said however there were issues over patient confidentiality in doctors reporting patients. "We will be asking the departments of health and transport to clarify the ethics and law in this area and to change to the law if necessary," a spokesman said.

The DVLA said there was no legal requirement on doctors to tell them if a patient was considered too ill to drive, although some doctors did in fact contact the agency. A spokeswoman said there was a reluctance to introduce compulsion because the issue of patient confidentiality was "a very sensitive area".

The inquiry concluded that the magnitude of the tragedy was not predictable. But it was predictable that Gadher would stop taking his medication and that if unwell he might become violent. It might have been prevented if he had been re-admitted hospital or prevented from driving.

At the time consultants and nurses faced excessive workloads and an inadequate range of services. More cash has been provided - but despite "strenuous efforts" the trust has been unable to appoint an additional consultant despite funds being available.