Family handoutA teenager left alone at a mental health hospital should have been under constant supervision when she self-harmed and later died, an inquest heard.
Ruth Szymankiewicz was being cared for by a member of staff on his first shift at Huntercombe Hospital, near Maidenhead, on 12 February 2022.
The 14-year-old, from Salisbury, was unaccompanied for about 15 minutes and left alone to walk around the hospital and to her room, assistant coroner Ian Wade KC said.
Shortly afterwards, she was found unconscious and died at the John Radcliffe Hospital in Oxford two days later.
Ruth was cared for on Thames ward, a psychiatric intensive care unit (PICU) at the hospital, from October 2021. She had been diagnosed with an eating disorder.
The hospital, which has since shut down, was rated inadequate and later requires improvement in two separate inspections by the Care Quality Commission (CQC) in 2021.
Her parents Kate and Mark said Ruth loved animals and reading and had a “fiery, determined” personality and a “huge heart”.
They said she “was and still is deeply loved” and that her death “shattered us”.
The jury heard she had climbed Kilimanjaro aged 11. She had lived for a time in Tanzania with her mother and father, a GP and surgeon respectively, and her two sisters.
‘Incredibly difficult to navigate’
Ruth was initially cared for on the children’s ward at Salisbury Hospital but was hurt when a nasogastric tube fed contents into a lung rather than her stomach in September 2021. She was transferred to Southampton for further care.
Days afterwards, her parents said they were told Ruth would be moved to Huntercombe Hospital, which they found had been poorly rated and was a two-hour drive away from their home.
Dr Szymankiewicz said the process for why Ruth needed to be moved to the hospital and onto a PICU was “opaque” and that the system was “incredibly difficult to navigate”.
“We wish we had fought harder. We had no idea how awful it would be,” she said in a statement.
She said there was “never any sense that staff thought it was important to communicate” with them about Ruth’s care.
Serious problems, such as Ruth drinking cleaning fluid and having black eyes, were not raised with them, Dr Szymankiewicz added.
It is thought the hospital worker, who was subsequently found to have false papers, returned to Ghana, where it is thought he was from.
The inquest, at Buckinghamshire Coroner’s Court in Beaconsfield, is expected to last for about two weeks.
