Heath board fined £100k after double suicide tragedy

Scotland’s biggest health board has been fined £100,000 in court after a mum-of-two suffocated herself with a bin liner at a Paisley hospital.

Louise Docherty, 27, was admitted to Dykebar Hospital with mental health issues and took her own life while out of sight of medics.

She had been assessed as being “a high risk of self harm and absconding”.

Miss Docherty was in the hospital in March 2014 when the senior charge nurse discovered her behind the door of her toilet with the plastic bag.

She was being treated in hospital after becoming unwell following the birth of her sons in 2011 and has since been described as a much-loved mother, sister and daughter.

There was a deterioration in her mental state in March 2014 and while in Dykebar she went to the toilet in her bedroom as the senior charge nurse took a phone call nearby.

When the staff member

returned minutes later, to allow Miss Docherty to speak to her social worker on the phone, there was no response from the toilet and something was blocking the door.

Yesterday, NHS Greater Glasgow and Clyde pled guilty at the city’s sheriff court to flouting health and safety by failing to properly carry out observations which lead to the tragic deaths of Miss Docherty and another patient called Kenneth McRae.

Procurator fiscal depute Catriona Dow said:“It was Louise blocking the door. It was noted she had a plastic bin liner used for hospital bins over her head.”

Attempts were made to save her and she was transferred to the Royal Alexandra Hospital by emergency ambulance, but tragically lost her life.

The court heard that 44-year-old medical student Mr McRae – also categorised as being“a high risk of self harm and absconding”– was found under the covers in his bed at Glasgow’s Stobhill Hospital with a bin liner over his head in September, 2012.

Since the incidents, the decision has been made to remove small bin liners from patients’rooms and en suite bathrooms.

The court heard that “had constant observations been properly implemented neither Mr McRae nor Miss Docherty would have been able to use a bin liner without being seen or heard”.

Sheriff Totten said the guilty plea by the health board“recognises that the deaths were avoidable and accepts responsibility for the defects which lead to them.”

The court heard Mr McRae had to give up his medical studies before his final year because of his mental health.

His sister and brother-in-law visited him on September 1, 2012, and before leaving found him to be“quite unwell”.

Ms Dow said Mr McRae was seen at 11.40pm on that day by a staff member.

He was noted to be“alert but not engaging”and around midnight, the member of staff carrying out constant observations saw only part of his body from outside the room.

Miss Dow added:“From her position in the corridor outside Mr McRae’s room, her view was restricted to the lower part of Mr McRae’s body.”

A short time later, Mr McRae was found under the bed covers with a bin liner around his head. Attempts to save him were unsuccessful and he tragically lost his life.

Sheriff Bill Totten fined the health board £100,000 reduced from £140,000 after admitting the failings.

Yesterday, a spokesman for NHS Greater Glasgow and Clyde said:“We have received the court’s decision and fully accept the findings.

“We have already put in place improvement plans within our in-patient care areas to minimise the risk of similar occurrences in the future.

“We note the sheriff recognised the board has a particularly good safety record and showed a high level of cooperation with the investigation.”

The spokesman said apologies have already been made to both families, adding that they will “be writing to them again reiterating this”.