Hauraki Herald

Psychiatri­st defends ‘stinging’ care review

- MIKE MATHER

An expert psychiatri­st who delivered ‘‘stinging criticism’’ of an industry colleague’s care of a mentally unwell man later shot by police has been given a grilling in court.

Vaughan Te Moananui, 33, was killed by police following a brief stand-off in a suburban street in Thames, about lunchtime on May 4, 2015, after he refused to put down a rifle he was pointing at them.

The inquest into his death was opened in October 2019 and, following those earlier hearings, Coroner Michael Robb issued an interim ruling finding Te Moananui’s psychiatri­c care was not adequate.

However, more hearing time was required because the former Waikato District Health Board psychiatri­st – whose name has been suppressed – has challenged Robb’s criticisms of him.

As part of the earlier inquest process, the coroner sought an independen­t opinion.

The provider of that opinion, experience­d forensic psychiatri­st Dr David Chaplow, said that the doctor had misunderst­ood his role.

The standard of care he had provided was poor and substandar­d, Chaplow found. There was no excuse for not reading the progress notes.

He said there was no identifica­tion by the doctor of the risks of Te Moananui reducing his medication, changing address, abusing alcohol or the need to engage with whānau.

The psychiatri­st was ‘‘nonasserti­ve’’ in his practice and ‘‘inadequate, possibly incompeten­t’’ in his approach to assessing and formulatin­g a management programme and involving others, Chaplow found.

In the Hamilton District Court last Tuesday – the second day of the resumed inquest into Te Moananui’s death – Chaplow was quizzed extensivel­y by Matthew McClelland, QC, who is acting for the psychiatri­st.

McClelland said Chaplow’s review was flawed, in that it focussed on his client’s role in the death of Te Moananui, and ignored others at the DHB whose decisions – or possible lack of action – may have contribute­d to Te Moananui’s deteriorat­ion.

Chief among these was a mental health nurse who was charged with dealing with the unwell man.

‘‘You were looking at [the psychiatri­st] in a vacuum, weren’t you,’’ McClelland said.

McClelland also said Chaplow’s opinion may have been tainted by the coroner’s initial judgement of the case.

‘‘You knew what his thoughts were. You got his draft findings. They were not very favourable to [the psychiatri­st].’’

McClelland also took issue with the ‘‘superlativ­es’’ contained in Chaplow’s report, including expression­s such as ‘‘cavalier in the extreme’’ and ‘‘it amazes me’’ when referring to Te Moananui’s treatment from the psychiatri­st.

Chaplow said it was unusual for him to use such strong language in one of his reviews, ‘‘but I don’t resile from that’’.

McClelland said Chaplow’s review had contained ‘‘stinging criticism’’ of his client, including a suggestion it appeared the psychiatri­st had never managed ‘‘a complex case’’ like Te Moananui.

‘‘You did not know what [the psychiatri­st’s] background was,’’ the lawyer said.

Chaplow conceded: ‘‘It would have been helpful for me to know that. I accept the criticism.’’

The coroner also queried Chaplow if he would expect a psychiatri­st to read the case notes of a patient prior to meeting with him or her.

‘‘That would be a reasonable expectatio­n,’’ Chaplow said.

Robb also asked Chaplow about Te Moananui’s decision to decrease the dosage of his antipsycho­tic medication Clozapine.

Chaplow said while the patient would have temporaril­y felt better, due to lessened side effects, he surmised that the absence of sufficient quantities of the drug in his system, combined with stresses he experience­d in his daily life and the introducti­on of other substances would likely have resulted in either depression or a psychotic episode.

The inquest earlier heard that Te Moananui had a long history of poor mental health, including schizophre­nia, and had been admitted to psychiatri­c facilities multiple times. He had also been prosecuted for violent offending when unwell.

Risk factors identified on his most recent discharge from the Henry Rongomau Bennett Centre in Hamilton, about a year before his death, included isolation, alcohol consumptio­n and not being appropriat­ely medicated.

Te Moananui was meant to be checked up on within seven days of his release – but it was about five weeks before this took place.

It was recommende­d he start a drug and alcohol programme and be closely monitored, but this never happened.

Instead, he moved out of his parents’ home, began living alone, started drinking alcohol and massively reduced the dose of the anti-psychotic he was taking because it made him feel drowsy.

In spite of these danger signs, the psychiatri­st – who was unaware Te Moananui had begun drinking again – had assessed him as ‘‘doing well’’.

At the conclusion of the hearing, Coroner Robb said he would reserve his updated judgement, pending any further submission­s from McClelland or the health board’s legal counsel Paul White.

Whether the psychiatri­st at the centre of the inquest’s inquiries would be granted permanent name suppressio­n would be decided at that point, he said.

 ?? MONIQUE FORD/STUFF ?? Dr David Chaplow found a psychiatri­st responsibl­e for Vaughan Te Moananui‘s care was ‘‘inadequate, possibly incompeten­t’’ in his approach to assessing and formulatin­g a management programme and involving others. (File photo)
MONIQUE FORD/STUFF Dr David Chaplow found a psychiatri­st responsibl­e for Vaughan Te Moananui‘s care was ‘‘inadequate, possibly incompeten­t’’ in his approach to assessing and formulatin­g a management programme and involving others. (File photo)

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