Family of woman who died after suicide attempt following hospital discharges successful in damages claim against health board

About this case:

• Citation:
  [2023] CSOH 1
• Judgment:
  External link
• Court:
  Court of Session Outer House
• Judge:
  Lord Arthurson

Violet Paterson, the mother of the deceased Lynette Gibson, as well as the deceased’s two siblings and two daughters, argued that staff at Lanarkshire Health Board had failed in their duty to take care of the deceased, who had been receiving treatment for mental health issues. The defenders denied that causation had been established and argued that the court would be unable to express a view on what led to the suicide attempt.

The case was heard by Lord Arthurson in the Outer House of the Court of Session. Smart KC and Waugh, advocate, appeared for the pursuers and Stephenson KC and Gardiner, advocate, for the defenders.

Rapid deterioration

The deceased had been diagnosed at the age of 16 as suffering from an emotionally unstable personality disorder. She had taken eight overdoses by the age of 14 and last took one in March 2016, a month where she had given evidence in an English court in the trial of a relative who was acquitted of sexually abusive conduct towards her. She was admitted to Hairmyres Hospital in East Kilbridge and detained on a short-term detention certification on 8 August 2016.

On 16 September 2016, the deceased was discharged from Hairmyres Hospital by a Dr Vusikala, who had treated her throughout her stay. Shortly after she moved from the family home that she shared with her husband and children to live with her mother in Glasgow. On 9 October 2016, the first pursuer returned home from the shops and found the deceased hanging behind the bathroom door by her dressing down. Ambulance staff attended and transported the deceased to the Southern General Hospital in Glasgow, where she died the following day.

Counsel for the pursuers submitted that a breach of duty of care had arisen during the intervening period between the deceased’s discharge from hospital and her death. There was a foreseeable risk of the occurrence of a devastating episode of self-harm or attempted suicide. Further, the defenders had failed to arrange follow-up care with a CPN in the 24 days following her discharge, and but for this negligence it was highly likely that the deceased’s condition would not have deteriorated as rapidly as it did.

Senior counsel for the defenders contended that there had been no evidence that the deceased had suffered a significant relapse after discharge. The pursuers’ causation argument relied on an inference of mental collapse but the only evidence on this point was speculative, and no evidence had been led from the clinical team that cared for the deceased in respect of what kind of follow up care would have been offered.

Not good enough

In his decision, Lord Arthurson began by saying: “A key moment in the evidence led at the proof arose in Dr Vusikala’s examination by the pursuers’ senior counsel when he accepted, again quite frankly, that he did not take any steps, having fixed an appointment with himself for 11 October 2016, to see to it that the deceased was receiving any follow-up in the community; and that the fixing of that consequent 24 day period prior to 11 October 2016, in respect of an inpatient such as the deceased who had been discharged from a short-term detention order while on anti- psychotic medication, was not usual practice.”

He continued: “It is trite to observe that Dr Vusikala plainly knew that the deceased was being discharged into the community with no EHS support. On that hypothesis of fact, Dr Vusikala was asked why, with his own knowledge of how the deceased had been in hospital as an inpatient, and with the knowledge that she was at home unsupported during the post-discharge period, he had indicated, as he accepted he had done, to CPN Hume that it was acceptable to postpone her appointment with CPN Hume to 11 October 2016. With equal candour Dr Vusikala’s response was that he did not have an answer to that. I have reached the view, in the whole circumstances of this truly tragic case, that this answer and approach are simply not good enough.”

Lord Arthurson said on causation: “In my view the deceased was foreseeably at risk of deterioration in respect of her psychiatric health following discharge. The approach adopted by the responsible clinician, and apparently endorsed by the defenders at proof, of leaving her to fend for herself with phone numbers only could not on any view be said to take into account the significant risk of deterioration applicable in her particular case.”

He concluded: “In all of these circumstances I hold that the completed suicide of the deceased in this case on 9 October 2016 was a direct consequence of the deterioration of her psychiatric condition following her discharge, being one of a range of damaging outcomes foreseeable in the whole circumstances.”

Lord Arthurson proceeded to make an award of £100,000 to the first pursuer, £5,000 each to the second and third pursuers, and £70,000 to the fourth and fifth pursuers.