Jamie Roe: neglect and understaffing allowed psychotic mental health inpatient to escape from hospital
Jamie Roe was a gentle and sweet-natured son, brother, and friend. At the time of his death, he was just 20 years old and suffering from psychosis. He was tragically struck by a lorry on 15th November 2021 after escaping from the mental health hospital where he was detained due to his risk to self.
A few days earlier, Jamie had been brought to Queen’s Medical Centre, Nottingham, after self-harming, and trying to climb a crane and jump out of a window. He was assessed as being psychotic and detained under the Mental Health Act. He had made several attempts to escape from the emergency department and was clearly identified as a high risk of absconsion.
Jamie was taken by secure ambulance to Fulbourn Hospital, Cambridge, where he was held on the ward behind a security system, which included an airlock with two sets of (locked) double doors. However, on the day that he died, Jamie was brought into the airlock for a visit with his mother in the family room. He was therefore held behind just one set of double doors. When the doors were opened to allow another patient to leave the building, Jamie ran outside.
The jury concluded the location of the family room was “inappropriate” because the airlock system was “compromised”. They also found that there was “insufficient staffing” and an “inadequate risk assessment” to allow for a safe visit, and that “further steps” should have been put in place. They therefore concluded that Jamie’s death was directly contributed to by neglect.
The case has been reported by the BBC - see here and here.
The family was represented by Matthew Turner instructed by Charlotte Haworth Hird and Amy Ooi of Bhatt Murphy
The Coroner was HM Assistant Coroner for Cambridgeshire and Peterborough, Mr Philip Barlow.
The other Interested Person was Cambridge and Peterborough NHS Foundation Trust (CPFT).
Matthew is a specialist in deaths in custody. He has secured eight neglect verdicts in different inquests since December 2021.
