Marcus Coates-Walker appeared for the family of Lillian (Lily) Lucas, a 28 year old mental health nurse, at the inquest into her death.
Lily had a long history of mental health difficulties and a diagnosis of schizophrenia. In June 2022 she was admitted as an NHS patient to Milton Ward at privately run Cygnet Hospital in Kewstone, Weston-Super-Mare under Section 3 of the Mental Health Act 1983. She initially made good progress, but her mental health acutely deteriorated in August 2022.
On 8 September 2022, Lily was seen to be drinking excessively from breakfast, which is a known risk for patients sufferring from Schizophrenia and required urgent medical review. However, no doctor was called. Lily showed signs of being increasingly unwell throughout the course of the day, until she became unresponsive in her room and suffered a cardiac arrest later that evening.
She was taken to hospital and passed away on 9 September 2022. A postmortem examination found that Lily died of a cardiac arrest, caused by an imbalance in her electrolytes as a result of excessive drinking consequent on psychogenic polydipsia and Schizophrenia.
The jury concluded that there were widespread “gross failings in her care amounting to neglect”, concerning compliance with hospital policies, observations and monitoring, attempts to stop her drinking, escalation for medical review and the response to her deteriorating condition. The jury also found that the ward was “understaffed at a level deemed to be unsafe”, which was a situation that had been present for months before Lily’s death and underpinned many of the failings on behalf of the hospital.
Marcus was instructed by Ali Cloak and Miryam Vermaat of RWK Goodman, who provided excellent assistance and representation of Lily’s family throughout the inquest. More information about the inquest can be found on the RWK Goodman website.
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