Ennis hospital death prompts HSE action

THE Government’s controversial national recruitment embargo should be lifted to ensure staffing shortages don’t undermine new Health Service Executive recommendations concerning acute psychiatric care at Ennis hospital, which were drafted following the tragic death of a patient.

The call was made this week by Psychiatric Nurses’ Association (PNA) representative, Denis Meehan, who believes Health Minister James Reilly should apply some common sense and flexibility to ensure staff continue adopting best practice in treating patients at the Acute Psychiatric Unit at Ennis hospital.
A jury sitting at an inquest into the death of 60-year-old Shannon man, Kevin Manifold, this week found he died at the acute unit of the Mid-Western Regional Hospital Ennis due to self-inflicted asphyxiation and attached eight recommendations made by the HSE to its verdict. 
The coroner’s court heard Mr Manifold had been diagnosed with schizophrenia and had been living with his twin brother prior to being admitted to the acute unit in Ennis on February 25, 2011.
Following their verdict, the jury requested eight recommendations made after a HSE review be implemented.
Commenting on the HSE recommendations, Mr Meehan said most of them are already being implemented.
However, he expressed concern about the ability of the Clare Mental Health Service to deliver all of them to their full extent because of the impact of the national recruitment embargo.
Mr Meehan claimed there is very little ongoing training or staff doing courses because of the chronic shortage of nurses. Prior to the start of the recruitment embargo in the spring of 2009, once staff went on training days, they were immediately replaced. This is no longer the case, however.
He warned that if there is a low level of staffing in the Acute Psychiatric Unit due to leave or sickness then it would be more difficult to maintain the usual levels of observation for certain vulnerable patients.
He said it is up to Minister Reilly to ensure the recruitment embargo is lifted to allow staff to participate in vital training courses as part of these recommendations and noted proper staffing levels for the overall Clare Mental Health service is vital.
Staff in the Ennis Acute Psychiatric Unit have previously completed vital training courses on CPR and appropriate patient restraint and safety to reduce the risk of pain being inflicted on a person who has to be restrained. Refresher courses for staff are regularly provided to ensure that all up-to-date procedures and policies for the treatment of patients are implemented.
Of the eight recommendations, the Mid-West HSE confirmed six have been implemented and another two are in the process of being so.
The HSE stated it regrets this unfortunate incident and has extended its sympathy to the brother of the deceased and his family and relatives.
At the inquest, Michael Griffin, business manager with HSE West, said eight recommendations were made after a HSE review was carried out in the wake of Mr Manifold’s death.
They recommended that if the community multi-disciplinary team suspect that there is an organic cause for a patient needing to be admitted to the acute psychiatric unit that they are firstly assessed in the emergency department of Ennis hospital or out of hours in the Mid-Western Regional Hospital, Limerick, prior to admission.
While patients have a level of observation determined at their multi-disciplinary team meetings, any sudden change in their condition must require that the level of observation be reviewed.
The HSE recommended all staff require ongoing education and training on policy and protocol on the use of increased level of nursing observation.
All staff have to adhere to the practice whereby all patients admitted to the acute psychiatric unit over a weekend period should be assessed by the consultant psychiatrist on call as soon as possible,  ideally within 24 hours, and the initial care plan should be reviewed following this.
The HSE stated all referral letters from community mental health teams to the acute psychiatric unit, at a minimum, should include reason for referral, mental state examination and list of current medication and any other information pertinent to the current admission.
“Clare Mental Health Services should regularly review the current multi-disciplinary team processes in use. All community mental health teams must have non consultant hospital doctor assigned to them.
“Medical teams working in the Mid-West Regional Hospital Ennis should be available to provide a consultation service-including, if required, an on site review to inpatients of the acute psychiatric unit,” the recommendations concluded.