Police launch investigation into patient death

The probe by Hertfordshire Constabulary relates to the case of Margaret Molyneux, 69, who according to a review by the trust’s commissioners, was prescribed doses of anti-psychotic medication which were significantly higher than recommended limits.

Police said the investigation is ongoing and no arrests have been made.

Ms Molyneux had been admitted to the trust’s mental health unit in Radlett in 2017, after which her physical health declined and she was admitted to Watford General Hospital with pneumonia and dysphagia, which relates to difficulties swallowing.

She was discharged back to the Radlett unit, but died several weeks later at Watford General Hospital, after choking on her food and developing aspiration pneumonia. 

An inquest in February 2018 ruled she died from natural causes, but an investigation into her case commissioned by East and North Hertfordshire Clinical Commissioning Group, seen by HSJ, subsequently suggested high doses of Olanzapine, an anti-psychotic drug, were “likely to have at least contributed to some of the physical problems she experienced… including low blood pressure, falls and dysphagia”.

The investigation also found she was made to stop smoking, which increases the effect of Olanzapine doses, and questioned whether the trust acted within section 58 of the Mental Health Act requirements, regarding their legal authority to prescribe the drug after three months. 

Papers from a private board meeting at HPUFT in March 2020, under a section headed “risk of reputational damage”, also seen by HSJ, said the trust said it would not carry out any further investigations or engagement with the family because there was unlikely to be a resolution which was to the family’s satisfaction so this “would not be productive”.

My Molyneux’s daughter Petria told HSJ: “Dysphagia is reversible when the anti-psychotic is reduced or stopped. It’s my belief that if Olanzapine had been stopped when the trust had no legal authority to carry on giving it, that my mother would not have choked whilst eating, aspirated or died of an aspiration pneumonia nearly three weeks later.”

Hertfordshire Partnership University Foundation Trust said it was unable to comment.

Hertfordshire Constabulary said: “Enquiries are currently being carried out by officers from Hertfordshire Constabulary’s safeguarding command, following allegations around the medical treatment of a woman who subsequently died in 2017. No arrests have been made at this time and the investigation is continuing.”

The charity INQUEST, which is supporting the family, said anti-psychotic medication is an important part of some mental health treatments, but has been linked to numerous premature deaths.

Last year, Avon and Somerset Police launched an investigation into the death of 18-year-old Oliver McGowan, who was prescribed Olanzapine against his own and his parents’ wishes and despite medical records showing he had an intolerance to anti-psychotics. At the time, a coroner ruled the care prior to his death was “appropriate”.

This story was updated at 14:52 to correct references to the Mental Health Act.

The comments section on this story has been closed as the police have said the investigation is ongoing.