BREAKING NEWS... Inquest verdict given into woman’s cliff-death
A MENTAL health unit has accepted responsibility for failing a woman in its care who went missing from the Leicester hospital and died the next day.
Sally Ann Vye (39) of Tennyson Way, Melton died at Beachy Head in East Sussex in June last year after battling with depression.
She had been in the care of the Bradgate Unit at Glenfield Hospital under Section 2 of the Mental Health Act when she absconded.
However, staff failed to record her absence for nearly eight hours and a search was only prompted when Miss Vye’s parents Ronald and Marilyn contacted the unit to check on her welfare.
Speaking after the verdict of a four-day inquest into her death at Leicester Town Hall today (Friday, February 15) Paul Miller, divisional director for adult mental health services at Leicestershire Partnership NHS Trust, said: “A number of errors by individuals contributed to Miss Vye’s death, which fell well short of the level of care we expect from our staff.
“I can provide reassurance that we took immediate action at the time of the incident and have implemented recommendations and actions to make sure that we reduce the risk of a tragic incident such as this happening again.”
The inquest had previously heard that Miss Vye had become increasingly depressed and anxious after being made redundant from her job as a shoe shop manager in December 2011 and had attempted suicide a number of times.
The 39-year-old had also previously absconded from the Bradgate Unit and travelled to Beachy Head but had been found by the local chaplaincy team.
The day before her death, Miss Vye had been let out of Beaumont Ward at the unit at 2.25pm on June 19 by a health care support worker who was going off duty.
Matthew Coring said he had looked at a ward document which said Miss Vye had been given the freedom to leave the ward unsupervised for a maximum of 30 minutes however, he did not tell senior staff or record the incident.
Giving evidence on the third day of the hearing, healthcare assistant Lisa Yeomans admitted filling in a head count sheet at 3pm and 4pm and incorrectly marking that Miss Vye was on the ward.
She said she correctly marked Miss Vye absent each hour from 5pm until she finished duty at 9pm but admitted she ignored procedure and did not report her missing to registered staff at the first opportunity.
As a result the alarm was not raised until 10.20pm when Miss Vye’s parents phoned the ward.
DC Patrick Coyle told the inquest that faulty record keeping and delays in raising the alarm had hindered the police search.
Recording the verdict, coroner Catherine Mason, said: “Despite the known existence of a real and immediate risk to Miss Vye’s life from self-harm, she was able to go missing due to not being properly observed in accordance with her needs.
“Furthermore, her whereabouts were not accurately recorded or reported due to a failure by NHS staff to follow policies and systems that were in place. This resulted in a delayed search for her.
“Although the evidence makes it entirely clear that on balance of probabilities Miss Vye could have been found sooner, it remains unknown whether the circumstances in which she was found would have been different.”
Speaking after the inquest Ronald Vye said: “A number of staff on Beaumont Ward, from the top to the bottom, failed to do the jobs that they were paid for. As a result Sally was unaccounted for, for nearly eight hours before she was reported missing.
“She was therefore denied the chance of being intercepted before she reached Beachy Head.
“Nothing can bring her back and Marilyn and I will miss her for the rest of our lives.”
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Tuesday 21 May 2013
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