Had Connors got medical help it might have saved man's life

ANALYSIS:The questions raised by the Connors case are much too serious to be dealt with by an internal HSE inquiry, writes Muiris Houston

THE CASE of Thomas Connors, who was found not guilty of murder by reason of insanity at the Central Criminal Court this week raises troubling questions about our psychiatric services.

The unfortunate saga points to a series of individual and systemic Health Service Executive (HSE) failures that suggest the standard of care given to Connors fell well below acceptable standards. At least three clear opportunities to intervene were missed; had any of these been properly grasped, it is entirely possible Michael Hughes could be alive today.

The 25-year-old from Mount Argus killed Hughes on December 15th, 2007, in a savage attack with a garden shears. The court heard Connors had paranoid schizophrenia and had required admission to hospital with psychosis in 2004 and 2005.

Dr Damian Mohan, consultant forensic psychiatrist at the Central Mental Hospital said that, in his professional opinion, Connors was legally insane when he stabbed Mr Hughes. He said Connors had religious delusions. The defendant believed he was God and that everyone else was Lucifer. He also believed his father-in-law was evil and that by killing Hughes, he was also killing his father-in-law. The majority of people with schizophrenia are not violent, but without adequate care, a minority may become so. The disease is characterised by delusions, especially in those with paranoid schizophrenia. Delusions are sometimes persecutory in nature, in which the sufferer believes that some of those around him are evil and are intent on causing harm. The person with schizophrenia may experience hallucinations, often in the form of voices telling them to cause harm to others. Schizophrenia can be successfully treated with antipsychotic medication.

What makes the case so tragic for Connors, Hughes and their families is the efforts Connors made to seek medical help in the days prior to the murder. Just four days beforehand, Mr Connors went to the emergency department of St James’s Hospital where he was seen by a triage nurse but then left. Some two days later he returned with his wife and child and told staff he had stopped taking his medication. According to his wife they were “sent away with some pills”.

The court heard that he was directed to St Vincent’s hospital on the basis that his address meant he fell within the catchment area of that hospital. Finally, he went to St Vincent’s, where a decision was made to admit him to St James’s Hospital, from where he had been referred the previous day. Connors waited a number of hours while an ambulance was arranged but absconded before the transport arrived.

Based on the evidence made public, there is now deep concern about the quality of psychiatric services in south Dublin.

The Connors case echoes the murder of Jonathan Zito by Christopher Clunis at a London underground station in December 1992. Clunis, who had a long history of schizophrenia, had been wandering the streets of London attacking people for some eight days before he stabbed Zito. The Ritchie Inquiry into the care given to Clunis highlighted a long catalogue of failures by doctors, nurses, social workers and the police.

It led to major changes in the way disturbed patients are looked after in Britain. Among its recommendations was the introduction of specialist teams to look after the most challenging patients. It also pointed to the obvious pitfalls when these patients move between catchment areas and called for the establishment of supervised care orders to allow the recall of patients who failed to comply with treatment.

Martin Rogan, assistant national director for mental health with the HSE, said yesterday that he will consult with colleagues before deciding whether to publish the results of an inquiry into the care given to Connors. This is completely unacceptable. Rogan should furnish the facts of the case to Hiqa, the Health Information and Quality Authority, to enable it to carry out an inquiry similar to the one it is presently conducting into cancer services at Ennis General Hospital.

Among the key questions that must be addressed are:

What was the result of Connors’s assessment by the triage nurse at St James’s Hospital?

When he returned two days later with his wife and child, why was he not admitted to St James’s Hospital? And why was he given a prescription for oral medication when he had already stopped taking tablets? Was he offered an intramuscular injection of anti-psychotic medication?

Did the staff at St James’s communicate with their counterparts in St Vincent’s at the time they referred Connors to his presumed catchment area hospital?

Following the decision to admit him to St James’s the next day, what steps were taken to expedite his transfer from St Vincent’s? Did the staff in St Vincent’s commence treatment?

Was Mrs Connors interviewed about her husband’s condition when she came with him to the hospital?

An independent report must contain detailed accounts of Connors’s treatment since he first came into contact with the State’s psychiatric services. Was he adequately followed up since he was first admitted to hospital in 2004? How many acute psychiatric beds were available in south County Dublin in the week of December 15th 2007? And were the area psychiatric teams fully staffed? The questions raised by the Connors case are too serious to be dealt with by an internal HSE inquiry. Minister for Health Mary Harney must order either a Hiqa investigation or a fully independent inquiry by a senior counsel. And if they have not already done so, patient organisations must reach out to the Hughes and Connors families. They will need support and encouragement to keep asking important questions about how our health system failed them.

Dr Muiris Houston is Medical Correspondent of The Irish Times