suicide watch would have saved patient
uicide watch would have saved patient
By Paul Jenkins
A REPORT into the death of a woman patient at a Stafford hospital says she could have been saved had staff checked on her overnight.
An internal investigation is being carried out into the death of a 28-year-old Willow Simpson who was found by staff at St George’s Hospital hanging from the window in her room on February 12 this year.
A Cannock inquest into her death heard an independent report which said Miss Simpson should have been on suicide watch after two previous attempts to take her own life.
It also criticised the system of checks on patients at the hospital and the lack of information on individuals given to staff after it found Miss Simpson had been told only seven days earlier that her son was being given up for adoption and she was unlikely to see him again.
The author of the report, independent case worker Julie Lloyd Roberts, said: “Miss Simpson relocated from Wales to Stafford in 2003 when a relationship broke down and she sufferered deteriorating health.
“In April 2006, she was re-admitted to St George’s’ Brocton Ward after an earlier short spell in the hospital.
“After seven months on the ward, she was coming to the end of her period there and the mental health team were looking to place her in supported accommodation.
“She had a meeting with social workers on February 7 to finalise the adoption process for her young son and was told she would have to apply for access to see him and there was nothing she could do to stop the proceedings.
“Staff on the ward didn’t notice her subsequent change of mood and there was no allowance for the possible risk to her health after the outcome of the meeting.
“She should have been on suicide watch after two previous attempts and was completely irrational and very ill at the time of her death.
“Checks were not made on her overnight and I have no doubt she would still be alive if they had been. “I realise the system of checks had been relaxed because of concerns from female patients about privacy and the noise of the doors opening, but their health and wellbeing should have overcome these complaints.”
Stanley Nevin, a health care support worker who was on duty the night before Miss Simpson died, said she had seemed fine and was smiling and chatting in the lounge before going to bed at midnight.
But when he went to wake her up at 7.15am the next morning he found the door locked and had to get his colleague to open it.
They subsequently found her hanging from a window in her bathroom and were unable to revive her.
He admitted he had not checked on her overnight between midnight and 7.15am and was not aware of the meeting she had recently had with her social worker.
But he said there was no fixed system of checks on patients and when it was felt necessary to check on them, it was not every 15 miutes, but more like every hour.
Coroner Andrew Haigh, in recording an open verdict, said it was clear Miss Simpson had killed herself but she was more upset than she appeared after the meeting with social workers and it may have been a cry for help.
He said the health care trust which runs the hospital had been criticised in the report for the haphazard distribution of information and system of checks, and this was being actively investigated.
Amanda Godfrey from South Staffordshire and Shropshire NHS Trust said it took incidents of this kind very seriously.
She said: “Any untoward incident is thoroughly investigated in line with our procedures and the trust endeavours to learn from and improve services as a result of such events.
“As an organisation, we also welcome the opportunity to receive feedback from users of our services, their carers and families and take their views very seriously.”
http://www.staffordshirenewsletter.co.uk/staffordshirenewsletter-news/displayarticle.asp?id
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