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Culpable for escape bid?

01 February 2005

When Miss S threw herself out of a first-floor window she fractured bones in her face, wrist, pelvis, spine and toes and lost a good many teeth.

She was suffering from a psychotic episode at the time and her leap from the window was not an attempt at self-harm but a bid for freedom from the psychiatric unit of her local general hospital, where she had been admitted the day before.

Three months later Miss S’s solicitors sent letters of claim to both the hospital authorities and the consultant in charge (an MPS member), alleging that they had failed to take reasonable care for her safety.

At issue was whether Miss S was kept under close enough observation and whether adequate precautions had been taken to prevent patients leaving the unit undetected.

In the opinion of the expert in psychiatry we consulted there were strong indications for providing Miss S with one-to-one nursing for the first few days after admission until the haloperidol she had been prescribed took effect.

During her first night in the unit Miss S was evidently in a very agitated state and keen to get away from the hospital; she managed to get as far as a nearby bus-stop on one occasion and made two more attempts to leave after she was returned.

An SHO, Dr M, who was on call that night prescribed IM haloperidol stat and benzatropine mesilate 2mg IM PRN. Later in the night, when Miss S had still not settled, she ordered 30mg flurazepam.

Dr M had asked that Miss S be kept under close observation (i.e. observed every 15 minutes) and this was done through the rest of the night and the following morning.

However, shortly after lunch Miss S managed to slip away through an unlocked door that led onto a connecting general ward. Here she climbed through a window onto a balcony and jumped.

According to the expert’s report, Dr M’s care of Miss S was inadequate, but he thought that the hospital bore much of the responsibility. Its procedure for arranging special nursing care was unclear and confusing and seemed to be concerned more with staff availability and financial considerations than with clinical need. He also felt that the hospital should be called to account for failing to provide a lock for the door connecting the psychiatric unit to the rest of the hospital.

The hospital took over the conduct of the defence for this claim and MPS’s role ended there.