Apology for 'tragic' suicide at hospital

Canterbury's chief medical officer has apologised after a man committed suicide in Christchurch Hospital's emergency department.

Nigel Millar told the Coroner's Court in Christchurch yesterday that the death of Trevor James McAlister, 41, was a "tragedy".

The hospital's systems were not "robust enough" in dealing with McAlister, who sought psychiatric help in September.

"We cannot, of course, turn the clock back ... however, we can learn from this event and do all that we can to prevent another such occurrence," Millar said.

The court also heard a statement from McAlister's sister, Lisa, who said the family had felt "let down" and believed the hospital had closed ranks when they sought an explanation.

Psychiatrist Allen Fraser said McAlister should have received urgent psychiatric help.

The court was told McAlister, who suffered depression and had a social phobia, had tried to kill himself that evening. He then contacted Psychiatric Emergency Services (PES) for help and was advised to take a taxi to the emergency department (ED).

McAlister arrived about 10pm, carrying his medical history. He appeared anxious and agitated. By 11.15pm, he was dead.

Nichola Collis, the triage nurse who assessed McAlister, told the court it was procedure to "medically clear" patients before referring them to PES.

She rated McAlister a category 4 medically with category 1 being urgent priority as he did not have any physical injuries from his suicide attempt.

McAlister waited alone in the waiting room, where he was observed rocking back and forth. Nurses moved him into a cubicle at 10.12pm for observation and he was upgraded to a category 3 to speed up the medical clearance process, Collis said.

McAlister was left alone while a nurse looked for a doctor. At 10.18pm, nurses noticed he was missing. He was then found dead in a room.

Fraser, an Auckland psychiatrist, said he was "unsure" why McAlister needed medical clearance before being seen by PES staff.

"Mental health staff are as able as ED staff to determine whether or not a patient is able to give a history or not as a result of the effects of a suicide attempt," he said. "It would certainly seem that Mr McAlister just wanted to talk to PES staff.

"We will never know how he interpreted being asked to wait in ED to see an ED doctor before being seen by PES staff. More importantly, had PES staff been able to see him they may have identified that he continued to be at high risk of suicide."

Fraser questioned the appropriateness of McAlister being "under the care of staff without the skills to appropriately assess and manage such a person".

Emergency department nurse Vera Fortune, who also attended McAlister, said there were "no set rules" about trying to decide whether someone was suicidal and she relied largely on experience.

PES clinical services manager David Egan said he had assessed McAlister as category 2 when speaking to him on the phone before referring him to the hospital. That rating "probably" would not have been passed on to hospital staff but that procedure had since changed.

"I felt with his engagement with the service and desire to be seen, risk wasn't imminent. Of course, that is incorrect, but at the time that's what I believed."

Whether a medical clearance was given or not, McAlister would have had to wait for assessment because of staff shortages and other at-risk patients who had priority, Egan said.