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UK medical centre fined after staff stabbed

Editorial Staff

Take out the ridiculous terminology and this report from the UK's Health and Safety Executive demonstrates the dilemma faced by medical centres which fall somewhere between hospitals and prisons staffed only with civilians.

The Health and Safety Executive, HSE, brought criminal proceedings against an NHS Trust, NHS Oxleas Foundation Trust, arising out of circumstances when what the HSE calls "a service user" attacked to members of staff. The patient, inmate (or whatever he was.. the ridiculous term obscures exactly what risk was posed) forced his way into a kitchen and grabbed a knife.

The circumstances show just how intrusive safety measures are required to be: ordinary activities performed in the ordinary course of duty must be subject to a risk assessment. Moreover, common sense is not enough: formal risk assessments are necessary and must be documented.

A "health care assistant" was preparing sandwiches in the kitchen attached to an "acute ward" at The Bracton Centre which is a "medium secure forensic unit" in Kent in South East England. Why not "medium security?" We've no idea. Write English, people, so the rest of us can understand. According to the Trust's website (which uses the same poor English demonstrating that it's become institutionalised) "The centre offers assessment, treatment and rehabilitation."

So, it's clear, then, that the place is populated with people with a variety of mental health problems of varying degrees but not those assessed as requiring a high degree of supervision or containment.

Myha Grant, a paranoid schizophrenic, had been jailed in June 2016 after he smashed a champagne bottle (you know those, if you drop them, they often bounce not break) over another man's head in what was described as "a random attack" in the street. He was transferred to the Bracton Centre where his behaviour was at best terrible. His mitigation included statements that he was spending up to GBP60 per day on long term smoking of "skunk" a particularly potent form of marijuana which is known to induce, amongst other things, paranoia and psychotic breaks. In addition he was regularly taking "spice," which has achieved notoriety as the drug of choice for prison inmates because it is powerful in very small doses and therefore relatively easy to smuggle (or drop from remotely operated aerial vehicles). Indeed, "spice" has been said to be one of the primary problems in prison population control as its users are literally out of their own or anyone else's control. There have been many deaths and also illness suffered as a result of secondary smoke.

It is clear, then, that Grant was a threat and that a "medium security" (we really cannot bring ourselves to type such poor grammar as the NHS and HSE uses) centre was not suitable. Two days after being sent there, the incident occurred.

The circumstances were those of everyday activity in a medical centre and even so, precautions were taken. Francis Barrett was preparing toasted sandwiches for patients and staff when a patient came to the door. Putting down his knife on the kitchen worktop, Barrett unlocked the door to speak the patient. As he did so, Grant pushed past him, grabbed the knife and inflicted 6 stab wounds on Barrett, to the abdomen, upper torso and arms. A psychiatric nurse, Julius Falomo, saw what was happening and shouted at Grant to stop. Grant then attacked him, inflicting 17 wounds. Then Grant went to his room, collected a lighter and clothes, returned to the ward and set fire to his clothes. By this time, armed police and an air ambulance had arrived. Two other members of staff hid. They filed "victim impact statements" having both taken time off work and undertaken counselling. Falamo and Barrett both spent a considerable time in hospital requiring, in Falomo's case, a series of operations to repair extensive damage.

The HSE said "An investigation by the Health and Safety Executive (HSE) found that although the Bracton Centre routinely received high-risk patients, at the time of this incident there was no patient specific risk assessment identifying the risks posed by a patient and the measures required to control those risks prior to admission to the ward. The investigation also found that the use of knives on an acute ward was fundamentally unsafe. Staff were entering and exiting the kitchen area several times whilst knives were in use and there were no instructions or control measures in place regarding kitchen knives. Following the incident all knives were removed from the acute wards."

The question of whether such a person should have been sent to such a Centre, staffed entirely by civilians, has been largely dismissed (by ignoring it) by the HSE. An HSE Inspector, Joanne Williams essentially blamed the Trust for the incident saying "“The treatment of patients in medium secure psychiatric units involves an inherent risk of violence and aggression. The needs of patients can be complex. However, the Trust nevertheless had a duty to ensure the safety of its staff and its patients so far as was reasonably practicable. “In this case there were relatively straightforward steps that could have been taken prior to the incident to prevent it happening. These included carrying out a patient specific risk assessment prior to admission to the ward; the removal of knives from acute admission wards, including Burgess Ward where patients do not routinely require occupational therapy; and proper training in search techniques. “The risk of violence posed by patients was entirely foreseeable. Had these steps been taken Francis Barrett and Julius Falomo would not have suffered the serious injuries that they did.”

The HSE does not appear to consider that someone such as Grant might just as easily found anything else useful as a weapon and the specifics of it being a knife are not really the point. it is to the shame of the Court that it did not think that through before imposing a substantial penalty that, ultimately, must come from the budget needed to pay for care for patients.

The Trust pleaded guilty and was fined GBP300,000.

Grant, on the other hand was ordered to be detained At Her Majesty's Pleasure (which means indefinitely) in the secure psychiatric unit at Broadmoor Hospital where his condition will be monitored. If it improves, he will be transferred to a prison to serve a sentence of 16 years (with parole after two thirds has been served) for the attack at the Bracton Centre.

At Grant's trial for the assaults in February 2017, Carey, J, said "The hard fact remains both men are deeply traumatised still by what occurred to them - and why on earth would they not be? They are both in a state of anxiety in relation to being in public and being at risk. Neither has made a full physical recovery."

Further reading: The spice epidemic in UK prisons is putting nurses at risk (https://www.theguardian.com/co...)

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