Two mental health nurses charged with unlawful killing of 22-year-old woman
THE last six observation checks on a vulnerable patient at the Oberlands Mental Health Centre were not carried out prior to her death, the Royal Court has been told.
We can report on the ongoing case today after reporting restrictions were lifted by the court that Lauren Ellis, 22, was found strangled with a binding around her neck. A post-mortem examination found she had died through ligature strangulation.
Mental health nurses Rory McDermott, 32, and Naomi Prestidge, 31, deny the joint unlawful killing of Miss Ellis through gross negligence on 12 October 2017.
The case has been running for 10 days and continues with the defence opening tomorrow.
Opening the prosecution case, Crown Advocate Chris Dunford said checks on Miss Ellis should have been carried out every 15 minutes. The last had been done at 1am. Miss Prestidge discovered what had happened, he said, only by chance at 2.42am, meaning all six checks prior had been missed. Having spent about an hour speaking on the telephone to her daughter, Miss Ellis' mother had called the Oberlands Centre at about 11.30pm the previous day and raised concerns with Mr McDermott about her daughter's state. He told her not to worry and said she would be all right, the prosecution said, but he never gave the message to Miss Prestidge. Within three hours Miss Ellis was dead.
Miss Prestidge was shift co-ordinator that night while Mr McDermott was in charge of medicines though he had completed that by 1am.
Advocate Dunford said both defendants were aware of Miss Ellis' condition, her extremely serious and long history of self-harm, and the fact that they had responsibility for her care. Defence counsel were likely to question and challenge some of the decisions taken.
'But it is the prosecution's position that checks were not done, so debating what could or should have been done is irrelevant and speculative,' he said.
At about 12.45am, psychiatrist Dr Rahul Bhintade had spoken to Miss Prestidge by telephone to tell her of the type of drugs which should be given to Miss Ellis. When she passed this on to Mr McDermott, he said the patient should have been given a line of Ket – Ketamine – a tranquilliser commonly used on horses but which can also be abused to get high. He told police in interview later that the remark had been made in poor taste.
Advocate Dunford said it was the prosecution case that the standard of care had been reasonable to 12.45am but then it had 'fallen off a cliff'.
Most cases of alleged negligence would be dealt with through a hospital's disciplinary system but sometimes things were so bad that criminal law intervened. This was such a case.
The court heard how Miss Ellis had been diagnosed with emotionally unstable personality disorder. She had been admitted to Crevichon Ward as a voluntary patient the day before her death. It had been a crisis admission as her recent self-harm had escalated to contain suicidal urges.
Miss Ellis had required hospital treatment because of her self-harming five times in the six days prior to her death – two of them on the day before she died.
It was not disputed that both defendants knew of the need to carry out observations, said Advocate Dunford. It had not been busy on the ward that night and both had had the time to do them.
Both defendants made false entries in the observation record check list in the minutes following the discovery of Miss Ellis' body, he said.
Both knew Miss Ellis and how seriously she would self-harm.
Both defendants had started their shifts at 8pm on 11 October. It was Miss Prestidge's seventh night shift in a row and Mr McDermott's third.
Advocate Dunford said Miss Prestidge discovered Miss Ellis' body by chance when she used the corridor outside her room to access the canteen.
CPR chest compressions were shared until an ambulance arrived at 2.55am and death was certified at 3.56am.
From about 1am both defendants could be seen on CCTV sitting in the staff room for a considerable period and engaging with one another, the prosecution said.
Miss Prestidge had her feet on a desk and was listening to music on her headphones. When police later seized her phone she said she had been browsing the internet. Mr McDermott admitted doing the same but in his break.
The court was asked why Miss Prestidge could be seen altering the observation check record list within about four minutes of Miss Ellis' death when she would have known that Miss Ellis was in serious trouble or even dead. 'Why was she wasting time when she should have been protecting Lauren?, asked Advocate Dunford. 'Was it self-preservation?'
CCTV footage showed clear panic among staff following the discovery of Miss Ellis' body, Advocate Dunford said. Police attended and circumstances were not believed to be suspicious at the time and the criminal investigation began only when CCTV was examined.
Both defendants were arrested on 7 November 2017. Miss Prestidge said in interview that she had had a busy week of night shifts and might have switched off at the time. She accepted making entries in the observation check record list but said she had done so in the belief that the checks had been done. She had used her phone to access music, online banking and the internet. She said she had also accessed Trakcare – the patient record system, though Advocate Dunford said this was disputed. She said she had been let down by the psychiatrists.
Mr McDermott told police he believed that Miss Ellis had been asleep by 1am and he had gone to help a colleague on another corridor for a while. He said he worked too many shifts and had taken too much on. He accepted that he should have told Miss Prestidge about the telephone call from Miss Ellis' mother and said he been looking for guidance from a psychiatrist.
Advocate Dunford said the ward was not under re-sourced and there was a process to enable staff to make complaints.
Miss Prestidge started work at the Oberlands Centre in June 2016. Mr McDermott started there in September 2016. Neither now work for Health & Social Care.
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