Alice Figueiredo. Image: Family of Alice Figueiredo
(Written by Local Democracy Reporter, Sebastian Mann)
22-year-old Alice Figueiredo died as an in-patient on the Hepworth ward in Goodmayes Hospital on 7th July 2015.
Amlan Basu, a forensic psychiatrist, was called up as an expert witness to the Old Bailey yesterday (17th December).
Representatives from North East London NHS Foundation Trust (NELFT), which oversees healthcare in Barking & Dagenham, Redbridge, Havering and Waltham Forest, have denied a charge of corporate manslaughter.
Benjamin Aninakwa, who was ward manager at the time of Alice’s death, pleaded not guilty to manslaughter by gross negligence.
Jurors were told that “more consistent reporting” would have made it “more obvious” there was a problem.
Alice had self-harmed using the same plastic items on 18 separate occasions in the months leading up to her death.
The Old Bailey previously heard that many incidents were not logged using the NHS’ dedicated software, Datix.
Dr Basu said: “If all incidents had been reported, senior management would have had a straightforward way of looking into [Alice’s] case.”
A separate witness, consultant forensic psychiatrist Nicholas Taylor, told the court today consistent entries on Datix meant the trust can track and respond to incidents.
He said: “Unless there’s consistency, the trust doesn’t know what’s happening within its organisation.
“If a trust is aware significant incidents are going unreported, then it’s important the trust does something about that.”
He added there wasn’t a need for “an excessive written record” of risks and triggers, but there needed to be an “understanding”.
Dr Basu said that the under-reporting of incidents was common across the NHS in 2015, but was “significant” regarding Alice.
As part of its patient care, the trust would devise treatment plans based on risk assessments, or risk formulations.
Separate expert witnesses said the expectation risk formulations were recorded was “too high” given the “realities” of general practice on a mental health ward, the court heard.
Dr Basu told the court that “you won’t always find this kind of documentation in the notes, despite training and prompts”.
However, “in a case as complicated as Alice’s, with its diagnostic complexity and risk unpredictability,” he said those expectations “should have been implemented”.
The expert witnesses, involved with psychiatric care, agreed Alice’s level of risk was “chronically high” and difficult to predict, the court heard.
She had been diagnosed with complex post-traumatic stress disorder, bipolar affective disorder, and an unspecified eating disorder. She had been readmitted to the Hepworth ward in February.
John Cooper KC, the defence for NELFT, quoted Dr Basu as saying that “none of [the experts] had met Alice” and it was “possible [their] views were influenced by knowing the fatal outcome”.
Dr Basu said that “hindsight bias” was a problem in psychiatry and he “did not feel comfortable” saying it was wrong for the ward to have reduced Alice’s observation levels before she died.
The trial continues.
