Orpen -v- HSE
Neutral citation IEHC 410.
High Court
Judgment was delivered by Mr Justice Iarfhlaith O’Neill on October 27th, 2010.
Judgment
The mother of a young man who died by suicide in November 2006 failed in her attempt to sue the HSE for damages claiming it breached its duty of care to her son when he presented himself at Letterkenny General Hospital.
Background
On November 14th, 2006, Michael Orpen presented at the accident and emergency department of Letterkenny General Hospital and said he had taken 50 to 60 tablets at about 6pm.
Mr Orpen said he had been depressed lately, had dropped out of his course in Letterkenny Regional College and could not cope with life’s pressures. He said he regretted his actions and would not attempt suicide again.
On examination he was found to be normal apart from a raised pulse rate. Toxicology tests were returned as normal. At about 11.30pm, he was referred to the psychiatric senior house officer on duty, Dr Margaret McGrory. His sister had been called to collect him and she arrived and waited while Dr McGrory conducted a psychiatric examination.
He described taking the tablets and driving around, considering driving off the pier but deciding against it. He detailed his personal and family history, denying any history of psychiatric illness in his family. He felt close to his parents but felt he was letting them down by dropping out of his course.
Dr McGrory concluded Mr Orpen was suffering from a depressive illness. He said he did not consider he needed to be admitted to hospital and said he had no intention of harming himself. She said she did not consider admission necessary and she wanted to engage with him in a treatment plan.
He said he was happy to go home with his sister, with whom he could talk if he felt he needed to. The sister was brought into the consultation room. She said in her evidence to the court that Mr Orpen had said he “really intended to drive off the pier”. Dr McGrory said she did not recall him saying this at this time, although he had mentioned it earlier.
Dr McGrory phoned the on-call consultant psychiatrist, Dr Gallagher. She told him she considered Mr Orpen to be a suicide risk, but not at that time. He was particularly interested in whom he was going home to, and was reassured that it was to a caring relative.
She confirmed Mr Orpen was to be discharged into his sister’s care and be referred next day to Parkview centre for counselling. At about noon the following day, Mr Orpen told his sister he had received a phone call to go to Parkview for counselling. This followed the referral by Dr McGrory which she marked as “urgent”.
Mr Orpen attended Parkview at 3.30pm the next day and had a lengthy assessment by a senior psychiatric nurse there. A significant addition to the information he provided was his habit of abusing alcohol and he reported low moods following bouts of drinking. He was asked to sign a form agreeing to abstain from alcohol and keep himself safe.
In a questionnaire he filled out, he stated he had no thoughts of harming himself. His answers attracted a score indicating “borderline clinical depression”.
The nurse wanted him to return to the centre the next day, but he said he had a work commitment in Malin so the next review was arranged for the day after, Friday November 17th. After his visit to Malin, he visited his parents in Dunkineely, where he declined to spend the night, instead leaving about 2am. He did not turn up for work the next day and his death was discovered when his car was found upside down off the pier at Bruckless.
His mother claimed the hospital had been negligent in its treatment of Michael. Evidence was given by a consultant psychiatrist at the Royal London Hospital, Dr John Cookson.
He criticised the absence of a diagnosis of depression and Dr McGrory’s failure to take a collateral history. Dr McGrory agreed she should at least have sought Mr Orpen’s consent to taking such a history from his sister, who might have revealed that his mother’s father, brother and sister had all died by suicide. However, Mr Orpen denied there was any psychiatric illness in his family and, when asked in Parkview if any family member had died by suicide, he denied it.
Dr Cookson said this family history, combined with his depression and other risk factors (he was male, young and single), made him a high suicide risk. He said he should have been admitted to hospital and, if he resisted, an attempt should have been made to persuade him. He accepted that resorting to legal powers to detain him involuntarily was not justified.
Decision
Mr Justice O’Neill said that depression was mentioned in Dr McGrory’s notes. He was satisfied there was no failure on her part or of Dr Gallagher to realise Mr Orpen was suffering from a depressive illness. Their treatment plan was to release him into the care of his sister, bringing him back to Parkview the next day to begin treatment for his depressive illness, thereby addressing the suicide risk.
They considered that at the point of his release, he did not present a suicide risk as he had come voluntarily to hospital seeking help and his sister was available to take him home.
Evidence called for the Health Service Executive revealed that very few depressions are treated in a hospital context and of those who attempt suicide by overdose, only 2 per cent take their own lives within the following year. Mr Justice O’Neill said he was quite satisfied that Dr McGrory did carry out an appropriate suicide risk assessment as part of her overall psychiatric assessment. He concluded that neither she nor Dr Gallagher failed in their duty of care owed to Mr Orpen and their approach was entirely consistent with good psychiatric care. He dismissed the plaintiff’s action.
The full judgment is on courts.ie
Eoin McGonagle SC, Richard Lyons SC and Miriam Reilly BL, instructed by DP Barry Co, Killybegs, for the plaintiff; Hugh Mohan SC and Michael Ramsey BL, instructed by V P McMullin Son, Ballyshannon, for the defendant