Inquest Learns How Mental Health Patient Was Able To Abscond From Hospital Unnoticed Before Suicide
07/09/2011
A distraught family has heard how a 48-year-old man, who was found hanged just 24 hours after absconding from a psychiatric hospital, was able to walk out of his ward completely unnoticed by nursing staff.
Ronald Fagan was found hanged from a tree by a dog walker on 30th October 2010, just 24 hours after he absconded unchallenged from Northampton’s Berrywood Hospital. He had previously been sectioned under the Mental Health Act after attempting to jump from a motorway bridge.
Mr Fagan’s psychiatrist, Dr Timmons, told HM Coroner for Northamptonshire that the former cub-scout leader from Towcester in Northamptonshire had a long history of mental health problems and was suffering with severe depression.
Following a verdict today that Mr Fagan had killed himself whilst the balance of his mind was disturbed; a medical negligence solicitor from Irwin Mitchell Solicitors said that the hospital must urgently learn lessons from this tragic death in order to safeguard the welfare of other vulnerable patients.
The inquest heard that Mr Fagan had been discovered in his car, parked in a lay-by, just two weeks before his death. He was taken to Northampton General Hospital and it was discovered that he had taken an over-dose of prescription medicine. A suicide note was found in the car stating that he wanted to end his life.
Mr Fagan was discharged but was informally admitted to Berrywood Hospital (formerly known as the Pendered Centre) the following day.
Six days later, Mr Fagan absconded from Berrywood Hospital and was found by police on a motorway bridge. Officers managed to stop the traffic below and Mr Fagan called off his threats to jump. He was returned to Berrywood Hospital and was sectioned under the Mental Health Act.
On 26th October 2010, Mr Fagan was visited in hospital by his wife, Dianne, who became concerned when she found blood on his sleeve. She alerted hospital staff, when she discovered that Mr Fagan had managed to harm himself with sharp metal from a drinks can.
When Mr Fagan absconded for the last time on 29th October 2010, his family was only informed when his wife called the hospital to check on his condition. She was horrified to learn that he had called the hospital to say he was in a field and had a rope with him.
Following a desperate wait for news, Mrs Fagan was visited by a police officer on October 30thto confirm that her husband had been found hanged from a tree.
Mr Fagan, a self-employed decorator, had been married for 20 years and leaves behind two children, Alex (19) and Charlotte (18).
Christopher Hurlston, a medical law solicitor from Irwin Mitchell Solicitors, who is representing the family, said: “We are grateful to the coroner for investigating Ron’s death and whilst the family feel that they received many answers, they still have important questions regarding the standard of care he received whilst at Berrywood Hospital.
“It is clear that Ron was very vulnerable and, following previous attempts to harm himself, it should have been apparent that he needed very close supervision and constant monitoring. Given the fact that his mental health had warranted him being formally sectioned, his family are appalled that just days later he was still placed on an open ward and simply allowed to walk out of the hospital unchallenged.
“We understand that since Ron’s death, the ward has changed from an ‘open’ to ‘locked door’ status, a move which sadly has come too late to prevent Ron’s tragic and untimely death. The Fagan family also has serious concerns regarding staffing levels in the unit and, in particular, the amount of time that staff physically spent with patients on the hospital ward.”
Dianne Fagan commented: “Ron meant the world to us. Although he had a long history of depression, he always tried to live a full life.
“His death has had a devastating effect on the entire family, especially our two children Alex and Charlotte, who miss him so much.”
“Ron was well known locally and played a big part in our community. He maintained the Christmas lights that were put up every year in Towcester village. He was also a leader in the local cubs group and used to help run Towcester Youth Coffee House, a youth club for children, which has sadly had to close down since his death.”
Christopher Hurlston added: “We are now calling for the hospital to prove that it has learned lessons from this appalling tragedy, to ensure that the welfare of other vulnerable people is fully safeguarded.
“Following today’s inquest the family will be considering its options, including the possibility of civil action against the Trust.”
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