In this clinical negligence case, the Court of Session awarded £250,000 to the family of a suicidal woman, having found failings in her care by NHS Lanarkshire.
Background
This case concerned the tragic death of 30-year-old Mrs Lynette Giblen, who had an extensive history of mental illness. She had been diagnosed with Emotionally Unstable Personality Disorder and had, on a number of previous occasions, been admitted to hospital following suicide attempts. In September 2016, Mrs Giblen had been admitted to Hairmyres Hospital and was detained under a short-term detention certificate. This was the third time that she had been detained in hospital for her own safety in less than two months, having, on a previous occasion, required admission to the psychiatric intensive care unit due to the severity of her symptoms.
During her admission in September 2016, Mrs Giblen initially required constant supervision. Her symptoms began to gradually improve, and she was eventually allowed home on an overnight pass. On her return to the ward, Mrs Giblen's clinical team noted that her mental health was "much improved". She was reviewed by her consultant psychiatrist and discharged on 19 September 2016.
However, whilst back in the community Mrs Giblen's mental health, once again, deteriorated. During this period Mrs Giblen did have multiple contacts with the Community Mental Health Team and her own GP practice, however she received no follow up care from her consultant or the Community Psychiatric Nurse (CPN) allocated to her on discharge. It transpired that her consultant had told the CPN that any follow up appointment with Mrs Giblen could wait until 11 October 2016. Additionally, Mrs Giblen's GP practice had not been informed by the hospital that she had not been receiving any additional support at home or any CPN input.
Mrs Giblen ultimately attempted to commit suicide by hanging on 9 September 2016. She was found by her mother and was taken to the Queen Elizabeth University Hospital in Glasgow, but sadly died two days later in the intensive care unit.
Legal Arguments
The pursuers (Mrs Giblen's mother, children and siblings) raised an action against the health board claiming that it was vicariously liable for the consultant's failure to ensure adequate care was provided to Mrs Giblen following her discharge. The pursuers led expert evidence to support their argument that, given Mrs Giblen's complex history of serious mental health issues, and the severity of her symptoms during recent admissions, it was not appropriate for her consultant to allow her to wait for over three weeks before receiving any further care. They claimed that, in the circumstances, the consultant had a duty to promptly arrange intensive follow up support for Mrs Giblen following her discharge and that, in the absence of such intensive follow up care, there was a foreseeable risk that Mrs Giblen's mental health would, again, deteriorate. The pursuers claimed that Mrs Giblen's suicide attempt was a consequence of that foreseeable risk ultimately materialising.
The defender disputed liability on several grounds, relying on expert evidence to argue the consultant acted reasonably and that the pursuers had failed to prove that, even if intensive follow up care had been arranged by the date they claim it ought to have been, the same unfortunate outcome would not have occurred.
Decision
Ultimately, Lord Arthurson found the pursuers had established it was foreseeable Mrs Giblen was at risk of deterioration in respect of her mental health following discharge, and that such a deterioration could result in a number of adverse outcomes, including a potential suicide attempt. In giving evidence, the consultant psychiatrist accepted that there was no clinical rationale for failing to organise any follow up care for Mrs Giblen until over three weeks after she was discharged. In reaching his decision, and whilst acknowledging the consultant's credibility and candour when giving evidence, Lord Arthurson found that the care received by Mrs Giblen was "not good enough" and that the reasonable psychiatrist would have taken steps to mitigate the known risks and would not have left this patient without support, for such a period.
Lord Arthurson had little difficulty accepting Mrs Giblen's suicide was a direct consequence of the deterioration of her condition and that, had her recent improvements been maintained by appropriate follow up care, her deterioration and consequent death could, and would, on the balance of probabilities, have been avoided.
Lord Arthurson therefore found in favour of the pursuers and made awards totalling £250,000 for loss of society (bereavement) under the Damages (Scotland) Act 2011.
Comment
This case is a reminder to public and private healthcare providers of the importance of ensuring adequate care plans are put in place for patients who may need follow up support, and that such plans are effectively implemented. The specific needs of individual patients need to be carefully considered so that potential risks to them can be identified and mitigated. Clinicians need to consider what potential adverse events might occur after patients are released from their care, as well as what might happen if such events do occur.
This case also emphasises that there must be a justifiable clinical rational for all decisions taken in respect of patients, including decisions not to provide follow up care post-discharge, and this rationale should be clearly documented.
