Department of Psychiatry at St Luke's Hospital prosecuted over dirty and undignified conditions

Appalling conditions at the Department of Psychiatry at St Luke's Hospital were outlined during a court hearing in Kilkenny today. 

The case was the first of its kind taken by the Mental Health Commission against the HSE under the Mental Health Act. 

The court heard that the HSE were pleading to four charges relating to conditions at the Department of Psychiatry. The failures relate to an unannounced inspection which took place at the psychiatric facillity between November 6 and 9 by the Mental Health Commission.

Judge Brian O'Shea imposed fines  totalling €5,200.

Judge O'Shea heard that the hospital had failed to ensure the premises met the needs of patients, it was not clean and a programme of maintenance was not in place.

"The inspectorate function of the Mental Health Commission is a hugely important one," he  said.

"For too long in this country, mental health issues have been ignored and stigmatised. The testimony of the inspectors and photographs [taken during the inspection] are the physical manifestation of that lack of care.

"What makes this worse is that the facilities here are those that house the most vulnerable people. Those people matter and the environment in which they are cared for matters," the judge said, adding that were it not for the inspection process, there would be "no mechanism" to bring such conditions to the outside world.

Judge O'Shea said that a comment made by assistant inspector Martin McMenamin that the state of the facility in Kilkenny "runs counter to everything a hospital should stand for" speaks volumes about the offences detected.

He didn't accept a "over-capacity argument" put forward by the HSE as part of the reason for the sub-standard conditions at the time "as much more than an excuse".

Giving evidence, assistant inspector with the MHC Martin McMenamin submitted photos to the court. 

The seclusion facilities were also not found to be clean or maintained to ensure the privacy of patients was respected.

Inspectors also found the seclusion register had not been signed by a consultant for one patient, as required.

Martin McMenamin, Assistant Inspector with the Mental Health Commission outlined how  the seclusion room had ingrained dirt on the floor.

He said there were also patches of food on the floor 

He said that the 'floor was tacky, shoes were sticking to the floor and that the room hadn't been cleaned properly for 'quite a while'.

He added that the air in the room was stale and that there was no natural light. He also told the court that the ventilation system was clogged with debris and dirt.

There was also cobwebs in the room and staining on the walls which was 'possibly bodily fluid'.

Another photo showed a corridor whose edges were 'very heavily contaminated with dirt', the inspector said, and there was an electrical switch with a hole underneath it which 'would present a hazard to a vulnerable person who might have been able to cause harm to themselves'.

The inside of an oven in the occupational therapy room, where patients might go to cook something as part of their recovery was 'really, really, really dirty," he said, and a room which was described as 'a courtyard' but had all the hallmarks of an internal room which was used by residents to smoke and was 'heavily contaminated' with dirt, with cigarette butts on the floor. 

Mr McMenamin said it was an affront to a patients' dignity to be placed in these conditions.

In another room with six patients, there was an open urine bottle,  and partially filled, close to drinking cups.

Mr McMenamin said that going into a treatment room, inspectors were almost assaulted by the smell and found a colostomy bag there.

The initial inspection took place on November 6 and two inspectors returned three days later and were 'disapoointed' to find that nothing had been done to improve the seclusion room.

"A seclusion room is there for a purpose and could be needed at any time," Mr McMenamin said.

"From our perspective, we would deem it as to have been unfit for purpose,"

His colleague made an 'impassioned plea' at a feedback meeting for conditions to be improved.

Inspector of Mental Health Services and consultant psychiatrist, Dr Susan Finnerty, said seclusion is used for detained patients whose challenging behaviour may pose a threat to themselves or others. The law requires a seclusion order to be signed by a consultant psychiatrist within 24 hours so that it's known that a consultant psychiatrist was involved with the seclusion.

Hospital management told inspectors they weren't aware that two patients had seclusion orders which weren't signed within the required time, Dr Finnerty said.

Shane Costelloe SC, for the HSE, put it to the witness that over €1 million has been spent on bringing the unit up to standard, and she said she was aware of this.

The hospital was in the process of hiring a new cleaning company, Mr Costelloe also said, and that "a remarkably different picture" is now in place regarding the conditions at St Luke's psychiatric unit, compared to last November.

Judge O'Shea fined the HSE €1,800 on each of the two charges relating to conditions at the unit and €800 on each of the two charges relating to the non-signing of seclusion orders.

He said that these facilities house the most vulnerable people and if it were not for the Mental Health Commission, the conditions would not be brought to the outside world.

He also noted the evidence of Mr McMenamin that the state of the facility ran contrary to everything a hospital should stand for.