Doctor failed to assess psychotic woman who killed her son just hours after leaving hospital, tribunal rules

TRAGIC END: Melanie Ruddell and son Christy in a photograph released as part of an ITV documentary into the case.
TRAGIC END: Melanie Ruddell and son Christy in a photograph released as part of an ITV documentary into the case.
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AN A&E doctor failed to ensure a psychotic woman was properly assessed before leaving hospital just hours before she killed her two-year-old son, a tribunal ruled.

Dr Clement Agbatar had a duty to ensure Melanie Ruddell was seen by the mental health crisis team at University Hospital of Hartlepool after she arrived by ambulance in August 2010, it was found.

Mrs Ruddell discharged herself and later that night strangled and stabbed her son Christy at her brother’s home in West Rainton.

Mrs Ruddell, formerly of Castle Eden, pleaded guilty to manslaughter on the grounds of diminished responsibility in February 2011 and was detained under the Mental Health Act.

A 2012 inquest ruled Christy had been unlawfully killed by his mother, but Sunderland Coroner Derek Winter questioned how she was ever allowed to discharge herself from hospital.

Dr Agbatar is accused of misconduct at a fitness to practise hearing at the Medical Practitioners Tribunal Service in Manchester, where Mrs Ruddell is referred to as Patient M. The MPTS panel yesterday found Dr Agbatar had failed to take account of the ambulance record, failed to adequately assess Mrs Ruddell, and failed to ensure she was assessed by the crisis team, but stopped short of finding him culpable of failing to ensure she was sectioned under the Mental Health Act.

Chairman Dr Susan O’Connor said: “Although you correctly referred Patient M to the crisis team, you had a duty to ensure that the assessment was carried out.

“You knew at the point that Patient M took her own discharge that an assessment was not going to be carried out at Hartlepool A&E department.

“Furthermore, you cancelled any further assessment by the crisis team. The panel considers this to be a culpable failing as Patient M was presenting with hallucinations and delusions, i.e. symptoms of psychosis.”

The tribunal has heard that Mrs Ruddell had been persuaded to go to hospital by friends and family on August 8, 2010, as she believed she had been drugged and raped on a works night out nine days earlier.

Dr Agbatar had claimed that he did not make a diagnosis, but the panel found there was sufficient evidence to indicate psychosis, as was suggested by his referral to the crisis team.

The General Medical Council, represented by Nigel Grundy, alleged that Dr Agbatar had failed to detain the patient under the Mental Health Act when it was clinically indicated.

But giving evidence, the doctor insisted he did not have the power to have her sectioned, and the panel agreed, clearing him of the charge.

Dr Agbatar was also found to have made mistakes in his treatment of another woman, known only as Patient A, who he treated at the Hartlepool hospital in September 2010 after she was assaulted by her ex-partner.

The tribunal ruled he did not recognise the abnormality of her low blood sugar and tachycardia, seek a medical opinion or refer her to the physicians.

The panel must now decide if any of his actions amounted to misconduct and if his fitness to practise is impaired as a result.

But, making submissions by telephone, Dr Agbatar told the panel he was “aggrieved” by the findings and asked to be taken off the medical register.

If the panel finds against the doctor he could face being struck off, suspended or only permitted to work under strict conditions.

l The hearing continues