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AN inquest into the death of an elderly Fivemiletown man has heard evidence from two independent psychiatrists on whether the medication he was prescribed in the days before his death could have been made more effective.
Ernest Kells (76), from Grogey Road, Fivemiletown, left the inpatient psychiatric unit at Oak Villa in the Tyrone and Fermanagh Hospital on April 2, 2021. His body was later recovered from the nearby Camowen River.
Mr Kells’ family have raised serious questions about how he was able to leave the unit through an unlocked door. A Serious Adverse Incident Report was carried out following his death, while a separate investigation was completed by the RQIA.
On the third and final day of oral evidence at the inquest on Thursday, expert psychiatrists Dr Matt Armstrong and Dr Conor Barton were questioned by legal representatives for Coroner Maria Dougan and for the Kells family about the medication prescribed to Mr Kells in the period leading up to his death.
The inquest heard that while both psychiatrists agreed on a broad range of issues, they differed in their views on the drug treatment plan, which had followed what was described as a ‘low and slow’ approach.
Dr Armstrong said that Mr Kells had been suffering from an ‘evolving psychosis’ which, in his opinion, required a different treatment strategy. While acknowledging that stronger or additional medication could have caused side effects, he said these could have been managed effectively.
He told the inquest there had been a ‘missed opportunity’ in the case, centred on whether a more robust administration of medication could have altered the outcome.
He questioned what the worst-case scenario would have been, suggesting that even potential side effects would have been preferable to the deterioration that occurred.
Dr Barton, responding to a suggestion that he was being ‘too kind’ in his assessment, said that Mr Kells’ ability to leave the ward through an unlocked door was an ‘unforeseeable complication’.
He said there was merit in the ‘low and slow’ approach, but noted there was no explanation in the records as to why that particular method had been adopted.
Dr Barton added that, given Mr Kells’ deteriorating condition, he should have been reviewed more frequently, and that his management plan should have evolved accordingly.
He said there was merit in a more ‘aggressive’ treatment plan and agreed with Dr Armstrong’s view that the dosing decisions recorded were ‘bizarre’.
Both psychiatrists agreed it was impossible to say whether stronger medication would have changed the outcome, but that a risk–benefit analysis should have been carried out as Mr Kells’ condition worsened.
The coroner said she will assess all the evidence before giving her findings at a later date.
