An 82-year-old woman died by suicide at the Royal Hobart Hospital after becoming distressed when a doctor raised the possibility of her moving into aged care.
The woman had been living independently at her home in Moonah before being admitted to hospital in September 2024 with several serious health conditions.
Eleven days into her hospital stay, a medical consultant discussed her care needs and raised the possibility of entering an aged care home. The woman became distressed and later told her daughter she did not “want to go on anymore” and “wanted to die”.
Her daughter raised concerns with nursing staff, who asked a doctor to review her.
Hospital records noted the woman appeared to be in a low mood and was frustrated by her lethargy and inability to feed herself. However, when the doctor attended that evening, the woman was asleep. The doctor chose not to wake her to discuss her distress.
A plan was instead made to consider a psychiatric or psychological review if her suicidal thoughts continued. The following morning, nursing staff found the woman dead in her hospital bed.
Coroner Olivia McTaggart found staff could not reasonably have foreseen that the woman would take her own life that night, or that she had the ability to do so. However, she found there had been a “missed opportunity” to respond to the woman’s suicidal thoughts in line with best practice.
This included conducting a full suicide risk assessment.
The coroner also found the Royal Hobart Hospital did not have adequate processes to ensure patients experiencing acute deterioration in their mental wellbeing were rapidly referred to mental health services.
The Tasmanian Health Service has since provided additional training to hospital staff. The coroner has recommended a review of the system for recognising and responding to acute deterioration in patients’ mental wellbeing.
This is very sad and preventable. I am a mental health nurse. More mental health nurses need to be employed at the hospital to assess rhe risk of patients on the wards. I certainly do not expect that this would ever happen, unfortunately!!