A psychiatrist has choked back tears as he apologised to the family of a patient who took her own life hours after he said she was not a danger to herself.
Dr Bob Boggs has described his “profound regret” over aspects of the care delivered to 33-year-old Orlaith Quinn, who died by suicide at the Royal Jubilee Maternity Hospital in Belfast less than two days after the birth of her third child.
The tragedy happened just hours after she admitted to her family and staff at the hospital that she had made three suicide attempts less than a week before the birth of her daughter, Meabh.
During the second day of the inquest into Mrs Quinn’s death, Dr Boggs, who was the psychiatrist who assessed the mum-of three from Dunmurry, fought back tears as he said: “I would just express my sorrow to the family one last time, my apologies.”
Mrs Quinn delivered her only daughter by a planned caesarean section on the morning of October 9, 2018.
Mrs Quinn’s husband, Ciaran, said the following day his wife’s behaviour changed suddenly as she revealed she had tried to kill herself three times five days previously, losing consciousness during the final attempt.
Mr Quinn has described his wife at the time as “manic, uncontrollable, loud, speaking irrationally, would not listen to reason, she was angry, upset and physically shaking”.
The inquest has been told Mrs Quinn said she believed she had caused brain damage to her daughter during the pregnancy, that she was disabled and would require a wheelchair as a result.
She also said she had ruined her family, that police were coming to arrest her and she would go to prison for the harm she had caused, the court has heard.
Subsequent to this, Dr Boggs was asked to assess Mrs Quinn and “exclude” a diagnosis of postpartum psychosis, he told the inquest.
During the assessment, he said she was calm and expressed regret at her earlier suicide attempts.
He noted she was able to comfort her husband when he became upset which he said was a “human gesture” showing she had empathy, something he would not expect to see in a person suffering from postpartum psychosis.
At the end of the assessment, Dr Boggs said he believed Mrs Quinn was suffering from obsessional neurosis, a common mental health condition where a person has obsessive thoughts and compulsive behaviours.
However, he was unable to rule out postpartum psychosis.
Despite this, he deemed she was “not actively or acutely suicidal at that time”.
“I believed what my patient told me,” he said.
As a result, he did not believe she required one-to-one supervision or transfer to a psychiatric ward and instead he recommended a “watchful waiting” approach and for Mrs Quinn to be reviewed the following day.
He explained: “As Mrs Quinn was on a maternity ward with trained staff present throughout the evening, night and morning, I considered she was in a place of safety.
“It remains a profound regret that Mrs Quinn died before she reached that appointment the next day.”
Commenting on the care plan put in place after the assessment, he said it “lacked detail” and he has since accepted the term “watchful waiting” may not have been fully understood by the midwifery staff.
“At the time I used this term I presumed this would have been understood by the maternity nurses, this is a matter of regret on my behalf,” he said.
Solicitor Patrick Mullarkey, who is representing the family of Mrs Quinn, asked Dr Boggs whether the management plan he recommended following her assessment should have reflected the possibility she was suffering from the more serious diagnosis of postpartum psychosis.
Dr Boggs said: “Unfortunately I allowed myself to be convinced by the patient.”
It also emerged during the hearing that notes written by Dr Boggs following the assessment stated Mrs Quinn experienced “no loss of consciousness” during her suicide attempt the previous week.
This conflicted with accounts she had given to her family and the midwife caring for her, who had recorded the admission in Mrs Quinn’s notes.
Dr Boggs told the inquest he noticed this in Mrs Quinn’s patient notes after the assessment, but at the time it did not lead him to question whether she had been entirely honest with him.
“I think in hindsight, it is more significant than I caught at the time,” he said.
He also expressed “profound regret” that he did not speak to Mr Quinn or Mrs Quinn’s mum following the assessment and ensure they were happy with the care plan that had been put in place.
Dr Boggs also told the inquest he was not aware of Mrs Quinn’s behaviour in front of her husband and mum when he concluded she was most likely suffering from obsessional neurosis.
He was asked whether the description given by Mr Quinn was a “fairly different presentation from the Orlaith you were speaking to” and replied: “Very.”
He was further asked: “And would it be fair to say that if she had been like that when you were speaking to her, you might have been taking a different view?”
Dr Boggs said: “No might. The other thing is that information, particularly the stuff about being arrested, that didn’t come to my ears. I wasn’t aware of that.”
He then agreed this behaviour was “passing into delusional rather than obsessional” and “passing towards psychosis and less towards obsessional”.
He told the inquest that had he been in “possession of all the information”, he would have diagnosed her with postpartum psychosis.
Earlier the inquest heard from Angela Flanagan, the band seven ward sister on duty working when Mrs Quinn’s mental health crisis came to light.
She told the court Dr Boggs only told her about the obsessional neurosis and it was only later that she became aware that he had not excluded postpartum psychosis as a potential diagnosis.
She agreed that this “raised a red flag” but she took her lead from Dr Boggs.
However, she said she would have wanted to be told by Dr Boggs that he had not ruled out postpartum psychosis as she would want to put in place an alternative management plan.
“She would certainly need one-to-one observation if they couldn’t provide psychiatric intervention that night or that evening, they should have been telling us they need one-to-one until we review the patient in the morning,” she explained.
Yesterday’s evidence came after Mrs Quinn’s husband told the inquest on Monday that he blames the hospital for her death.
Mrs Quinn was moved to a side room on the advice of Dr Boggs, who believed she would benefit from “low stimulus” environment.
However, it has emerged the room was closer to the exit of the ward and people leaving or entering the room could not be seen from the nurse’s station.
Mr Quinn stayed with his wife overnight to provide her with support; however, he awoke in the early hours of October 11 and realised she was missing.
Mrs Quinn was subsequently found dead at the end of the corridor of the ward from which she had gone missing.
The inquest continues today at Laganside Court in Belfast.
If you, or anyone close to you, have been affected by any issues in this article, please contact the Samaritans free on 116123 or Lifeline on 080 8808 8000.