Hospital changes made after death of man at “high risk of suicide”

Date: Friday 15th June 2012

HOSPITAL procedures have been changed following the death of a Penrith man, an inquest was told this week.

Jonathan (Johnny) Routledge lived at Musgrave Street, in the town, prior to his death in January, 2011, at the age of 43.

Mr. Routledge was found hanged in the garage at his home and coroner Ian Smith ruled on Thursday that he had died “as a consequence of his own actions while suffering from acute mental illness”.

At a three-day hearing in Kendal, the coroner heard evidence from Mr. Routledge’s mother, Isabel, of Penrith, and a friend, nurses, a GP and psychiatric doctors.

Mr. Routledge worked as a crime scene investigator with Cumbria police, having previously served with the RAF. He was passionate about custom motorcycles and had a wide circle of friends with whom he shared this interest.

The hearing was told that the onset of his mental health problems, in December, 2010, was very sudden. A “trigger” event on 10th December occurred when he heard a loud “cracking” noise in his house. This was later found to have been caused by an old piece of polystyrene coving which had split away from the wall but Mr. Routledge was convinced that the sound was the result of an underlying structural problem with the building.

The house had previously been underpinned and Mr. Routledge had had problems getting insurance, which greatly added to his acute state of anxiety.

Two visits to a GP were followed, on 16th December, by admission to the Hadrian unit an acute psychiatric ward at the Carleton Clinic, Carlisle, run by the Cumbria Partnership NHS Foundation Trust.

Over the next 21 days, Mr. Routledge had three short spells as an inpatient at the clinic, with periods of “home leave” between. On 4th January he was discharged as an inpatient with his care to continue under a “crisis team”, in the community and on 5th January he took his own life.

Witnesses testified that during the course of his illness Mr. Routledge had gone through periods of acute anxiety, during which he was at “high risk” of suicide. These were interspersed with periods when he was more stable and felt he could cope with his problems. He had continued to have spells of “catastrophic thinking” and been readmitted to the clinic on 28th December, 2010, suffering from acute anxiety and suicidal thoughts. This inpatient stay came to an end on 1st January, when he was once again released on home leave, to stay at his mother’s house.

Returning to the clinic on 4th January for a scheduled meeting, Mr. Routledge was seen by a junior doctor, Dr. Marcin Krawzck who agreed his discharge from the unit. It was stressed that this did not mean his treatment would end, but that it would be provided at home by a specialist “crisis team”.

Dr. Krawzck was cross-examined by a barrister representing Mrs. Routledge about the decision to discharge her son. He testified that although the consultant psychiatrist overseeing Mr. Routledge’s case Dr. Stephen Humphries was on leave until 5th January, had he felt doubts about the decision he could have consulted with an on-call senior doctor.

Dr. Humphries also took the stand and was questioned in detail about his involvement in Mr. Routledge’s treatment and the decision to discharge him.

Summing up, the coroner addressed a number of issues which had been raised during the hearing. He questioned whether the short periods that Mr. Routledge spent in the Hadrian unit were “sufficient” for medics to build up a true picture of his illness.

He flagged up the fact that cognitive behavioural therapy (CBT), although a key part of the treatment plan for Mr. Routledge, was not started formally while he was in the unit and, although he planned to have the CBT treatment through his workplace, this had not been followed up either by Mr. Routledge or by the unit.

He said the arrangements surrounding Mr. Routledge’s discharge from the unit were “not clear cut”, and noted that a risk assessment document had not been completed.

Mr. Smith also noted concerns that had been raised about the prescription of the antidepressant drug Citalopram to Mr. Routledge, and its possible side-effects.

An incident report drawn up after Mr. Routledge’s death on behalf of the NHS trust made a number of recommendations, the hearing was told. These included that a senior doctor should always be consulted before a patient was discharged, and that a risk assessment document always be updated at the time of discharge.

Mr. Smith declined to write a formal letter to the trust highlighting the issues raised by the case, concluding: “I think that the trust is already well aware of the problems that occurred problems in relation to risk assessment and discharge.”