Palmerston North Hospital. Photo:
The family of a man found dead after he failed to return to the mental health ward at Palmerston North Hospital, where he was a patient, remain in the dark about what happened almost nine months on.
Philip Lucas, 69, left the hospital on 24 December when granted approved leave. A month later his body was found near Kāpiti Island, and the coroner was investigating his death.
The ward at Palmerston North Hospital, known as Ward 21, was in 2015 found unfit for purpose after the suspected suicides of patients Shaun Gray and Erica Hume the year before. Inquests into their deaths were held last year and Coroner Matthew Bates has reserved his decisions.
The government signed off on a replacement ward in 2020 and it was supposed to open late last year, but construction was delayed amid a cost blowout. It will now open in 2025.
Construction on the new ward started earlier this year. It's expected to finish in 2025. Photo: RNZ / Jimmy Ellingham
Since 2015, more ward patients have died in matters that have been or are before coroners.
Lucas' family still doesn't know for sure what happened on Christmas Eve last year and in the days before, and Te Whatu Ora MidCentral was yet to complete a serious adverse event review report, which was now well overdue.
"The family doesn't know more than what they knew at the start of this process and there are no real answers to date," a family spokesperson told RNZ.
The family had questions about what happened after Lucas failed to return, including "real concern" about how they were not notified sooner and how long it took hospital staff to inform police.
"The delay in the review process being completed and the lack of communication has caused significant emotional trauma to the family over and above Philip's death," the spokesperson said.
Te Whatu Ora was asked for an interview. In a statement, it said it was unable to discuss details of Lucas' care and its actions after he disappeared due to the ongoing review.
A subsequent statement attributed to Te Whatu Ora MidCentral clinical executive and consultant psychiatrist Alison Masters said the organisation empathised with Lucas' family and recognised the difficult time they had experienced over the past few months.
"MidCentral is in regular contact with members of the deceased's family to keep them updated on the progress of the review," she said.
"We acknowledge this serious adverse event review has taken longer than is optimal to complete due to staff shortages within the team. MidCentral is actively attempting to recruit into the team to mitigate long processing times for such reviews.
"We are committed to completing the review as soon as possible without compromising accuracy and ensuring the deceased is given the respect of exactness and thoroughness."
A coroner is investigating Philip Lucas' death. Photo: Supplied
Masters said the Health Quality and Safety Commission set a 120 working-day period in which serious adverse events reports must be completed, from the time of the event, and Te Whatu Ora was now 45 days over that.
"It is anticipated this review will be completed before the end of the year."
However, the 120-day period was only introduced in July. Before that, it was 70 days from when a 'provider', in this case Te Whatu Ora MidCentral, was notified of a serious event - meaning it is now 95 days overdue.
The family spokesperson said they were concerned to see Te Whatu Ora cite staff shortages as a reason for the report's delay, given that the problem had been apparent for some time.
Hospital admission and disappearance
RNZ understands Lucas was admitted to the mental health ward as a patient on 10 December. He was classed as a voluntary patient, but the family spokesperson said they were still unsure of his status and why Lucas was not held as a compulsory patient under legislation.
In the days following his admission there was evidence of suicidal thoughts, low moods and unease.
On 21 December he was described as anxious and reporting "low moods". He said if he stayed on his medication, his symptoms would worsen.
The following day Lucas said he was "boxing on", and when asked whether he had suicidal thoughts said: "That is a hard question to answer."
An artist's impression shows the under-construction mental health ward at Palmerston North. Photo: Supplied
A psychiatrist thought Lucas was improving, and he enjoyed a Christmas BBQ.
On 23 December there were "no psychotic features evident" and he was allowed to leave the ward as he pleased for up to eight hours.
On Christmas Eve he approached a nurse early in the morning and asked for leave for the day, saying he would return to the ward about 2 or 3pm. His mood appeared good and he denied there were any risks.
"The family has concerns about how Philip was assessed as going from unwell to being able to leave within a very short time," the family spokesperson said.
Lucas did not return to the ward and his family and police were informed that evening.
Lucas' house was checked on Christmas Day and Boxing Day, and on 26 December his family gave police a photo of him. This was posted online and sent to media on 2 January.
By 27 December, police were treating Lucas' disappearance as a priority.
Attempts were made to ring Lucas' phone, but it turned out to be still on the ward, which might have made initial search attempts focus on the area around the hospital due to cell tower data placing the phone there.
On 29 December hospital security was advised of a request for camera footage, while a search of the hospital grounds was requested by an acting charge nurse. It was unclear when this happened.
Police searched the hospital grounds on 3 January, but found nothing.
Police told RNZ they were unable to comment while the case was before the coroner.
Were changes made?
In 2017, Simon Oakley, a voluntary patient at the ward, died by suicide after taking leave.
Despite being just metres from the ward's entrance, his body was not found for six days. The area near the entrance was searched after he failed to return, but was not checked again until search and rescue personnel did so.
After Oakley's death, the then-MidCentral District Health Board head of security said security workers would from then on immediately obtain more information about missing patients and call in extra staff if patients hadn't returned within 72 hours of taking leave.
Last year, MidCentral's then-mental health and addictions operations executive Scott Ambridge said there were new processes for patients requesting leave, where staff asked a wider set of questions about how patients felt and the state they were in.
Leave was granted more gradually, beginning with patients being escorted by staff or family, he said.
It was unclear if this happened in Lucas' case.
Philip Lucas was a patient at the Palmerston North Hospital mental health ward in December last year. Photo: Supplied
RNZ asked Te Whatu Ora if the changes in practice MidCentral said it had introduced after Oakley's death were followed, but it didn't answer, citing the serious adverse event review in progress.
Also unanswered were questions about how long it took for police and hospital security to be informed about Lucas' disappearance, and what Te Whatu Ora's policy for this was, and when searches of the grounds began.
The construction of the new ward was originally budgeted to cost $30 million, with a contingency of $5m extra.
Earlier this year, Te Whatu Ora papers revealed costs on the delayed project had gone up 71 percent, and the ministers of health and finance - Dr Ayesha Verrall and Grant Robertson, respectively - had to sign off Te Whatu Ora's request for more funds.
Te Whatu Ora initially declined to tell RNZ what was the new budget, but publicly accessible information on its website puts it at $60m.
Te Whatu Ora's website said the new 28-bed facility, replacing the current 24-bed ward, had an "estimated date of practical completion" in the April-June 2025 quarter.
"Work is under way on the new building's foundations. LT McGuinness was recently selected as the main contractor."
According to council consent documents, the new ward will be a 2797 square-metre, single-storey building facing Heretaunga Street.
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