NHS Grampian must pay £64,500 after it pleaded guilty to falling foul of health and safety legislation in the case of Vincent Mulsant, 40.

Mr Mulsant had been admitted to the Royal Cornhill Hospital, Aberdeen on December 31, 2019, but had absconded from the ward twice.

As a result he was placed under supervision.

An investigation by the Health and Safety Executive (HSE) found, however, that NHS Grampian had not ensured he was protected from risks to his health and safety given that he was at a high risk of suicide.

Two staff found Mr Mulsant lying on the bathroom floor on March 28, 2020. He was pronounced dead at the scene.

Last week, NHS Grampian pleaded guilty to breaching the Health And Safety At Work, etc. Act 1974.

Sheriff Morag McLaughlin said: “No size of penalty can adequately reflect or compensate for the loss suffered by Mr Mulsant’s family as a result of this tragic incident.

“They ought reasonably to have been able to assume Mr Mulsant was safe from the risk he otherwise posed to himself. It is difficult to comprehend fully the devastation they must have felt and must continue to feel at his loss, which was clearly preventable and the impact of which I can only begin to imagine.”

An HSE spokesman said: “This tragic case highlights the need for suitable and sufficient systems to be put in place to ensure vulnerable patients are kept safe while they are in hospital.”

An NHS Grampian spokesman added: “We apologise unreservedly for the failings that led to this tragic incident.

“Lessons have been learned and significant improvements made as a result. However, we remain deeply sorry to the family of Mr Mulsant for their loss.”