'A patient cannot be forced to stay in the hospital', pensioner's death inquest hears

Patrick Rowland's daughter Sally, son Hugh, wife Louisa, son Cormac, and his wife Marcella attended the final day of the inquest into Patrick's death. Picture: Conor McKeown

A grandfather who drowned accidentally after leaving hospital while very unwell could not have been detained there as “a hospital is not a prison”, a coroner has ruled.

Patrick Rowland, 69, described in court as “a good citizen” and “a pillar of a man”, was probably suffering sepsis and pneumonia when he left Mayo University Hospital in an "agitated" state wearing pyjamas and slippers after midnight on January 17, 2023.

He had been on a trolley for “upwards of 42 hours” before being given a bed, and “had expressed his desire to go home multiple times".

CCTV showed the much loved husband, father, grandfather, and brother walking through Castlebar wearing pyjamas in freezing January weather that night.

He had called his son Cormac and told him he was leaving the hospital after 1am that morning. However, despite searching for his father that night, Mr Rowland’s body was found in the river two days later.

He had died of asphyxia due to drowning and his death was accidental, coroner Patrick O’Connor ruled on Monday.

“It is abundantly clear that Patrick Rowland did not want to stay in Mayo University Hospital,” Mr O’Connor told Swinford Coroner’s Court.

“A hospital is not a prison. While Patrick Rowland was admitted with significant medical conditions, he was not detained therein under the Mental Health Act.

There are limited powers available to the staff in a hospital to detain a patient

“Any patient is entitled to take his or her own view as to whether he wishes to stay in a hospital.

“A patient cannot be forced to stay in the hospital. A patient cannot be physically detained in a hospital.

“It was Patrick Rowland’s own choice to leave the hospital.” 

Patrick Rowland, 69, had called his son Cormac and told him he was leaving the hospital before he later accidentally drowned.

Following the verdict, Cormac Rowland said that the family contested this. Although the hospital denied that Mr Rowland was confused or delirious, Cormac said that his father was “not compos mentis, he wasn’t in the fullness of his mind”, and was not medically fit to make that decision for himself.

“Everybody could see how fraught he was, how out of kilter he was,” Cormac said.

The inquest previously heard how Mr Rowland appeared to meet several criteria for being at risk of leaving the hospital, but night nurses were not told.

The coroner made five recommendations for Mayo University Hospital on Monday after hearing four days of oral evidence and 31 witness depositions. 

These included that training should be given to all hospital staff to deal with patients who express a desire to self-discharge.

For patients at risk of absconding, a formal guideline to report and record such risk should be in place — and these documents should form part of a patient’s medical record.

All relevant clinical and non-clinical information regarding a patient should be recorded and given to the new hospital team at handover, the coroner recommended.

He also recommended that the hospital's guidelines on sepsis and the recording of the early warning scores be adhered to.

Luán Ó Braonáin SC, acting for Mayo University Hospital, said that the HSE extended 'sincere condolences' to the family. Picture: Conor McKeown

The coroner also recommended that Mayo County Council examine the railing by the river in Castlebar, where Mr Rowland’s slipper was found, and warning signs be considered for that location.

An appropriate barrier was also recommended in the river closer to Castlebar town, to prevent anyone who enters the water from being washed far downriver. Mr Rowland’s body was found two miles from where he entered the water.

Roger Murray SC, acting for the family, said that they were pleased with the coroner’s “five strong recommendations” for the hospital, which they believe are very necessary to implement.

Key clinical information about Mr Rowland had not been given to staff when handing over care of the ward the night Mr Rowland left the hospital, Mr Murray said.

It's the family's steadfast position that had that information been given, Patrick would not have left the hospital

“In fact, the nurse who gave evidence during the inquest […] said that, had the full picture been known to the staff at Ward B, certain safety netting would have been put into place, Patrick would have been accompanied, etc, and other mitigating factors put into place."

While the family accepts that Mr Rowland's entering the water was likely accidental, they still questioned why he ended up in that position, Mr Murray said.

“The family's position is that, had he been where they thought he was [...] tucked up in bed in the hospital with the side rails up on the bed, and that had the full facts been transmitted to the hospital staff on the night in question, Patrick never would have been near a river and this calamity wouldn't have befallen him.” 

While the family accepts that Mr Rowland's entering the water was likely accidental, they still questioned why he ended up in that position. Picture: Conor McKeown

The family is contemplating civil proceedings now against the HSE, Mr Murray said.

More than 20 family and friends attended Monday’s inquest for Mr Rowland, who was described by the coroner as a “much loved and respected husband, father, and community person”.

Mr Rowland, of Tubbernavine, Lahardane, Mayo, was a pensioner at the time of his death.

His son Cormac said that his father was a “hero to me” and a “pillar of a man”.

My father was a good citizen. He adhered to the rules and regulations of this country

“He was a GAA man, a community man. The way he met his end causes us great distress and an awful lot of angst."

That distress is something they now "live with on a daily basis," having to drive past the place where Mr Rowland ended up in the river on their daily commute to work. 

“It is very difficult. The tributaries of my own mind are filled with this every day […] the ‘what ifs’.” 

He said that the hospital’s policy on potentially absconding patients needs to be more proactive.

“If somebody is hitting markers or articulating that they want to leave, well then that has to be a red light and you have to be in a situation where that gets passed on from one part of the hospital to the other.

“The crux of all this is the lack of communication from one place to the next. My father slipped through the cracks and, ultimately, we have to bear that burden and carry that load.” 

Luán Ó Braonáin SC, acting for Mayo University Hospital, said that the HSE extended "sincere condolences" to the family.