A man who 'rolled' into the road and was hit by a taxi after being discharged from hospital had said he was suffering from drug withdrawal and wanted an admission to detox from Spice, an inquest heard.
Daniel Kirton tragically died following the collision, which came after he had attempted to take his own life on hospital grounds following his discharge by mental health practitioners. He had attended Manchester Royal Infirmary's emergency department earlier that afternoon, December 3, 2020, and was assessed by staff from the Greater Manchester Mental Health NHS Foundation Trust but deemed fit to be released.
At an earlier hearing of the six day inquest at Manchester Coroner's Court, police coroners' officer Elizabeth Davies told the court Daniel, 35, who was of no fixed address and was unemployed, went to the hospital to see the mental health team on the afternoon of December 3. He was assessed again a short while later before being 'escorted' out of the hospital at around 11.15pm, when security officers based at MRI got a radio call from colleagues telling them there was an 'aggressive male' refusing to leave the department.
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During the fifth day of the hearing today (November 23), MRI mental health nurse Godfrey Chiveya described how he had seen Daniel standing on a raised flower bed outside the hospital. The court heard he had made threats to take his own life. Mr Chiveya said: "I spoke to him, he was not very happy to see me."
Barrister Sam Harmel, representing Mr Kirton's family, said Mr Kirton had said he wanted an admission to detox from Spice and said he was 'rattling' - suffering from symptoms of drug withdrawal.
Daniel then left the hospital grounds and was hit by a taxi nearby, on Upper Brook Street, at around 11.37pm - 22 minutes after first being escorted out of the emergency department.
In court on Wednesday, Mr Harmel questioned Mr Chiveya over whether mental health teams had considered Mr Kirton's 'level of suicidality'.
Mr Harmel asked Mr Chiveya: "Did you consider his level of suicidality?"
Mr Chiveya said: "Yes, it was considered."
When Mr Harmel pointed out Mr Chiveya had said the opposite when he last gave evidence, Mr Chiveya explained he "had been mistaken."
Mr Harmel again asked: "Did you or did you not explore Daniel's suicidality?" Mr Chiveya replied: "It was explored."
Barrister Jonathan Robinshaw asked Mr Chiveya whether he had interpreted Daniel's behaviour as 'conditioned threats' - "a case of 'you did not help me in A&E, so I am not going to engage with you'." Mr Chiveya agreed.
He noted Mr Kirton had fluctuated between saying he was going to hurt himself, and then saying he would hurt someone else, if he was not admitted. Mr Robinshaw said: "He suggested he may hang himself, he looked around and saw some railings and said he may impale himself on some railings, he then looked around and saw some cars and said he may jump in front of some cars. A patient presents with an altering plan, does that imply a lack of intent? Mr Chiveya replied: "Yes."
Giving evidence, mental health nurse Cara Oates, from North Manchester General Hospital, explained that an initial assessment of Mr Kirton would have been carried out in A&E by Mr Chiveya and there would then have been two options - to discharge him or to pass to a gate keeper who could say at that stage whether the patient should be admitted to hospital.
Area Coroner Zak Golombeck asked Ms Oates: "Would it have been possible for Mr Chiveya to have said: 'We have assessed him outside of the hospital and we think there should have been a gatekeeper assessment'?" Ms Oates replied: "I don't know."
Mr Golombeck continued to say it was his understanding that Ms Oates felt Mr Kirton should have been given an offer to come back to A&E for further assessment. Ms Oates agreed, saying: "Yes, that is correct."
Mr Harmel referred to notes saying Mr Kirton 'had been told someone would see him tomorrow', despite no such referral being made. He asked her: "Is it ever appropriate to tell a patient 'we will see you tomorrow' if a referral had not been made? Are there ever any circumstances where it is appropriate to tell a patient something that isn't right?"
Ms Oates said it was not. Mr Harmel continued: "The assessment outside of A&E was not appropriate, would you agree with me?" She replied "Yes."
Barrister Jonathan Robinshaw asked Ms Oates "Would you say Mr Chiveya had good rapport with Mr Kirton outside A&E?" She replied: "No."
He then asked: "Is it important for a good rapport between patient and practitioner?" to which Ms Oates agreed it was. Mr Robinsonshaw continued: "He (Mr Kirton) might therefore have been reluctant to have gone with Mr Chiveya as their relationship had seemingly broken down at that point?" Ms Oates answered: "Yes, that is correct."
The inquest continues.
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