Shane O’Connor, who died by suicide almost two years ago, was not receiving required one-to-one, around-the-clock supervision when he absconded from Tallaght University Hospital (TUH) less than 24 hours before his death, an inquest has heard.
The 17-year-old son of musicians Sinéad O’Connor and Dónal Lunny was found dead in an area of secluded wasteland behind Corke Abbey housing estate between Bray and Shankill on January 7th, 2022.
He was admitted to TUH on December 29th, 2021 after he made a “serious” attempt to take his own life two days earlier, a sitting of Dublin District Coroner’s Court heard on Monday.
Viewed as a “high-risk” patient by psychiatrists due to the seriousness of his suicide attempt, Shane was prescribed 24-hour, one-to-one supervision during his hospital stay. At the time of his admission, he was under the care of Tusla, the Child and Family Agency.
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The court heard evidence that on various occasions during his admission, supervision was not provided to Shane. On the morning of January 6th – when he absconded from TUH – there were no healthcare assistants available at the hospital to supervise him due to understaffing, the court heard.
Prof Anthony O’Connor, a gastroenterology consultant overseeing Shane’s care while at TUH, said that “generally” one-to-one supervision of patients is provided by hospital staff. He said Shane’s supervision was “cobbled together” during his admission, provided at different times by his father Mr Lunny, care workers who were familiar with Shane and hospital healthcare assistants.
Prof O’Connor said that while it was clear that Shane was unwell and troubled, his “gentleness, kindness and creativity” were apparent to all who cared for him.
Florence Lambert, a clinical nurse manager, said nurses on Shane’s ward realised he was missing from his single room at about 10.30am on January 6th, the court heard. The ward was understaffed that day, the court heard.
After hospital staff reviewed CCTV footage, it was determined that Shane had left the hospital at about 10am, and both gardaí and Tusla were subsequently informed he was missing.
Dr Paula McKay, a consultant psychiatrist at TUH who cared for Shane during his admission, said she was not made aware of gaps in his supervision. She told coroner Dr Cróna Gallagher that had she known, she would have “escalated” the case, “because this was a very high risk”.
Dr McKay outlined plans that were in train to involuntarily admit Shane to Linn Dara, a HSE Child and Adolescent Mental Health Services (Camhs) facility, following his stay at TUH. At the time he absconded, Shane was awaiting transfer to Linn Dara – subject to a court order – having recovered from the impacts of the suicide attempt.
Mary Rose McCarthy, a psychiatrist attached to Camhs in Co Kildare, gave detailed evidence of Shane’s prior admissions to Linn Dara, his various diagnoses with mental and behavioural disorders and psychotic episodes, the impact of his sustained cannabis use and previous instances of his suicidal ideation and behaviour.
Seán O’Connor, Shane’s grandfather, had objected to Ms McCarthy providing detailed evidence. He said it was “accepted” that Shane had a difficult youth and had a difficult time “with the politics of the day”. The court heard that Shane had spent time in care since he was 11 years old.
He said Shane’s late mother Sinéad often spoke about her son, and to do them both justice there was no use in “raking over dead embers”.
“A child arrived in hospital sick,” he said. “We’re talking about the systems that allowed him to escape.”
A brief deposition provided by Ms O’Connor was read on to the court record. In the deposition, she said she identified her son to gardaí at the mortuary at St Columcille’s Hospital in Loughlinstown, south Dublin, on January 8th.
Several members of Shane’s family were present in court on Monday, including his father and his uncle, the writer Joseph O’Connor.
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