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Inquest into the death of Aaron Greenidge

Alison Millar represented the family of Aaron Greenidge at his inquest

Posted on 15 November 2010

At the time of his death, Aaron Greenidge was detained under section 3 of the Mental Health Act at Queen Mary’s Hospital, Roehampton. Aaron was 22 years old and suffered from Paranoid Schizophrenia. Since the time of his first psychotic breakdown in March 2006, he had been admitted to Hospital 13 times on a “revolving-door” basis. Aaron was known to struggle with hallucinations of trains talking to him and telling him to kill himself. He absconded from Queen Mary’s Hospital at around 20.45 on 9 April 2010. Tragically, he was struck by a Train at Tooting Broadway Station at around 21.30.

The Inquest touching on Aaron’s death was held on 30 September and 1 October 2010 at Westminster Coroner’s Court. The Coroner heard evidence that due to pressure on hospital beds, Aaron underwent multiple ward transfers whilst he was under section at Queen Mary’s hospital. Aaron was most comfortable on Laurel Ward, the ward for his catchment area where he was familiar with the staff. Although he was a patient on Lavender Ward at the time of his death, he continued to spend much of his time on Laurel Ward as a visitor and he attended ward rounds there.  

The Coroner heard that Aaron was under particular stress at the time of his death. He was facing a decision regarding his accommodation and his flat had recently been burgled. The Coroner heard that Aaron had been granted unescorted leave without review of these stress factors and that he had been extending his periods of leave at his own will. The Coroner commented on the apparent escalation in Aaron’s levels of anger and agitation in the days leading up to his death. On the evening of his death, Aaron was involved with an altercation with another patient. He was being escorted to the Lavender ward at the time he absconded. The Coroner viewed CCTV footage of Aaron walking out of the hospital. There was no attempt to stop Aaron or persuade him not to leave.

Aaron’s father, Mr Anthony Greenidge, gave evidence regarding his concerns about Aaron’s care at Queen Mary’s Hospital. He expressed his frustrations about Aaron’s rapid cycles of admission and discharge and his prolonged periods of unescorted leave.

Giving a narrative verdict, the Coroner concluded that Aaron Greenidge was known to be impulsive and at a high risk of self harm. She identified a difficulty maintaining clinical overview of Aaron’s mental state as a result of ward transfers, lengthy periods of unescorted leave and the fact that Aaron spent much of his time on Laurel Ward as a visitor.
Alison Millar of Leigh Day & Co acted for Aaron’s family at the Inquest. She commented on the Coroner’s verdict:

“The inquest into Aaron’s death has highlighted some serious concerns about the lack of overview and supervision of  psychiatric patients at Queen Mary’s Hospital.”

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