Gemma Ingham
19 Apr 2022 · Coroner Nigel Meadows · Manchester City
The coroner's concerns
1. inadequate or incomplete clinical record keeping
“The repeated instances of inadequate or incomplete necessary clink clinical record keeping”
2. discharge to community HBTT care without readiness
“The decision made to discharge to community HBTT care when they had indicated that the patient was not ready for supported community care and there had been no clear clinical rationale”
3. discharging vulnerable adult with long forensic history
“Discharging a patient with a long forensic history and inconsistent engagement with mental health services who still required administered Depot antipsychotic medication and was a vulnerable adult”
4. inadequate and incomplete risk assessments and mental state examinations
“Inadequate and incomplete risk assessments and mental state examinations”
5. discharging patient without fixed abode or community support
“Discharging a patient who had no appropriate fixed abode and no established community family support arrangements”
6. failure to consider safeguarding referral and assessment
“A significant failure to consider a safeguarding referral and assessment for a vulnerable adult suffering from serious mental disorder”
Responses
No published response was found on judiciary.uk.