Suicidal man worried he could harm family sent home due to difficulties finding bed, inquest told
A man who presented at A&E suicidal and worried he might harm his family was sent home with an outpatient appointment following difficulties finding him a bed, an inquest heard.
Father-of-two Raymond Pierce (46) was found dead by his wife at their home at Broadford Lawn, Ballinteer in Dublin 16 on March 15, 2013, the morning after he was referred to St Vincent’s Hospital A&E with “active suicidal thinking”. He had been transferred to Cluain Mhuire Services (CMS), the community mental health service for his catchment area, who were unable to secure him a bed.
Dublin Coroner’s Court heard Mr Pierce developed post-traumatic stress disorder following a 1997 incident where someone fatally jumped in front of the train he was driving.
He was referred to A&E on March 14 by Iarnrod Eireann chief medical officer Dr Declan Whelan after presenting at his surgery “actively suicidal”. Mr Pierce had previously attempted suicide in January and received treatment in St Patrick’s Hospital.
His sister Ann Sheehy said he was “extremely agitated and distressed" and she called her husband to bring them to the hospital. They were seen promptly and Dr Barbara Byrne, then registrar in psychiatry at St Vincent's, interviewed him privately and in their presence. Mr Pierce volunteered for treatment.
Mrs Sheehy said he was offered an outpatient appointment with CMS for the following day but they refused to leave until they “got results”. Dr Byrne eventually secured a late appointment that afternoon with Dr Siobhan Barry, CMS consultant psychiatrist. Mrs Sheehy claimed Dr Byrne told them that “officially” there were no beds available but if Dr Barry considered it serious enough there would be one.
However, Mrs Sheehy said that following the consultation with Dr Barry, during which her brother was “literally attempting to climb the walls”, there was no bed available in St John of Gods, where CMS rents inpatient beds. Attempts to secure a bed in St Vincent’s were also unsuccessful. She said the outpatient appointment the next day was the only option available and Dr Barry’s “parting words” to her brother were: “Can you hold on until tomorrow?”.
Dr Byrne told the inquest she did not know what the situation with beds was when she referred Mr Pierce to CMS. She may have “given the impression that further care would be arranged”, she said, but her assessment would be “trumped” by a consultant psychiatrist.
Dr Byrne earlier told the inquest Mr Pierce had symptoms of a depressive episode with active suicidal thinking. He also had thoughts toward his wife and children telling her “it would cause less pain if I took them with me”, she said. His friend John Keenan had earlier given evidence that Mr Pierce told him he intended to kill himself “because he was afraid of the harm he would cause to others”.
She said she suggested the outpatient appointment on the suggestion of consultant psychiatrist on duty Professor Kevin Malone. When the family found this unacceptable, she secured an assessment with the consultant psychiatrist in Mr Pierce’s catchment area as instructed by Prof Malone. She agreed that she considered Mr Pierce to be “extremely high risk”.
Prof Malone said St Vincent’s refers 700 similar patients to services in their own catchment areas annually. He agreed that Mr Pierce needed “acute psychiatric care” and said he was “satisfied” this “equated to the consultant psychiatrist seeing the patient that afternoon”.
The inquest continues.