Call to protect vulnerable adults
‘‘There are still families with adult autistic people who have nowhere to go, and no-one to turn to.’’
Autism New Zealand chief executive Dane Dougan
A service devoted to protecting vulnerable adults could help prevent another murder like that of autistic woman Ruby Knox, advocates say.
The 20-year-old Blenheim woman was a large and sometimes violent non-verbal, autistic woman, with a severe intellectual disability as well as a raft of serious health problems. She was smothered to death in 2016 by her mother and sole caregiver Donella Knox, who later told authorities she felt abandoned by the medical fraternity.
While Knox was sentenced to four years in prison last year, the services used by Ruby and Knox were independently reviewed by leading paediatrician Dr Rosemary Marks for the Nelson Marlborough District Health Board.
Marks released her findings this week, saying that unless the Ministry of Health worked with all DHBs to ensure the needs of adults with disabilities were met, ‘‘there will be more Rubys’’.
She called for the Government to establish an adult safeguarding service, to protect vulnerable adults like Ruby. Such a service could have saved her, Marks said.
In the months before Ruby’s death, Knox was ‘‘tearful and stressed’’, and was regularly visiting the emergency department at Wairau Hospital, in Blenheim, believing her daughter was in great pain. She twice threatened to harm Ruby.
But then Knox would claim she was ‘‘just venting’’. Staff were reluctant to get police involved, in case it needlessly damaged their already fragile relationship with Knox, Marks found.
Their reluctance was shared by health professionals across the country, Marks said. ‘‘A call to the police would not result in a different outcome.’’
An adult safeguarding service, similar to Oranga Tamariki, the Ministry for Vulnerable Children, could investigate concerns about protecting vulnerable adults without necessarily getting police involved, Marks said.
‘‘If there had been an organisation like Oranga Tamariki to go and have a more in-depth conversation, that may have gone some way to preventing this.’’
Autism New Zealand chief executive Dane Dougan said he backed Marks’s call for an adult safeguarding service.
‘‘There are still families with adult autistic people who have nowhere to go, and no-one to turn to. It would be ideal if there was a place they could go, to ensure the safety of the person diagnosed, but also to support the family as well,’’ Dougan said.
‘‘The people helping her were in the job for the right reasons. The fault lies with the system, and I think that’s what we hear around the country, too.’’
Marks also called for an early warning score system, which would electronically collate patient information from GPs, hospitals, disability support services, Oranga Tamariki and school records.
Unusual behaviour, such as an increase in GP or hospital visits or reduced use of funded support, would trigger a social work assessment.
Marks also called for better mental health services for people with intellectual disabilities. The DHB had limited dual diagnosis services for adults with both intellectual disability and mental health issues, she said.
Knox was Ruby’s sole caregiver. She got the most funded respite care in the region and possibly in the country, Marks said. She refused to put Ruby in residential care, against staff advice.
‘‘There is no system to ensure that all people providing respite care to children and adults with disability receive appropriate training,’’ Marks said. ‘‘As a result, many families lack trust in the system.’’
Families struggled to find suitable caregivers because they had long been underfunded and lacked training in best practice, Marks said. She called for better resourcing for carers, and improved monitoring of care standards in residential care facilities.
Ministry of Health disability support service group manager Toni Atkinson said two pilot programmes were about to start that could form the basis of wider reform in the disability sector.