A psychiatrist has denied accusations she failed to provide a review board with a full and frank account of her concerns of a patient's suicide risk just weeks before the depressed woman left the country to kill herself with a euthanasia drug.
The mental health treatment of the 39-year-old mother of four, whose name is suppressed and is known as “Ms D”, is under the microscope at a coronial inquest this week.
After six weeks of involuntary treatment at King Edward Memorial Hospital's mother baby unit, the Mental Health Review Board removed the woman’s involuntary status after she promised to stay at the unit voluntarily and take her medication. The next day she discharged herself and was put on a community treatment order under the care of Fremantle Hospital’s Alma St Clinic.
Just a few weeks later, Ms D left the country, took a euthanasia drug and was found unconscious in her hotel room, dying 10 days later in a foreign hospital on May 10, 2008.
Before her review, mother baby unit staff found evidence of a suicide plan in Ms D’s belongings, including a travel itinerary, passport application and an overdue library slip for a book about euthanasia.
Soon after her status was changed, staff found traveller’s cheques hidden under the woman’s bed, but that discovery did not trigger a reassessment.
Dr Mojdeh Bassiri, a part-time psychiatric registrar at the mother baby unit, wrote a report for the board and addressed the three-member panel about the treating team’s concerns that Ms D’s suicide risk was still high and that she should remain an involuntary patient.
However, Dr Bassiri told the inquest she was not the psychiatrist most actively involved in Ms D’s treatment.
She said Ms D had been evasive and difficult to engage with, but had shown signs of improvement during her involuntary stay.
Under questioning from a lawyer representing Ms D’s family that she wasn’t forthright enough with the board, Dr Bassiri said she believed she was explicit with the panel about her concerns the woman knew what was at stake and how to present herself well in order to get off involuntary status.
She said she told the board that doctors doubted whether Ms D would genuinely be able to comply with treatment if left to her own devices and that they remained very concerned she was at risk of acting on her elaborate overseas suicide plan.
“Tragically and unfortunately I predicted what would happen,” she said.
Dr Bassiri said she was “surprised” by the board’s decision and had expected them to keep Ms D on an involuntary order.
She was accused of not picking up Ms D on all the lies she was telling the board, but the psychiatrist said she did raise some of them but did not think it would be beneficial to confront Ms D aggressively or antagonise her.
But Dr Bassiri said the woman’s safety was her overriding priority, although maintaining patient rapport was also important.
Dr Bassiri told the board that depending on the woman’s progress there was a possibility of looking at discharging her within a week or so.
She told the inquest if given more of an opportunity to detail her report, which the board had not read and had instead requested a verbal report, she could have perhaps highlighted her concerns more clearly, but still believed she did convey the main points adequately.
The inquest continues.