Schizophrenic axe-killer Lachlan Jones' failure to take his medication was not helped by the psychiatric team caring for him, the inquest into the death of Jones and his flatmate, Malcolm Beggs, was told yesterday.
Dr Ian Goodwin, an Auckland specialist in attempted suicide and self-mutilation cases called in by the coroner, Mate Frankovich, to report on the care of Jones, said the dispensing practices used by the team included putting medication in a patient's letterbox.
"Practices ... such as giving medication to flatmates who may have no knowledge of their appropriate dispensing does not seem, to this reviewer, to fulfil adequate standards of practice."
On the seventh day of the inquest, Dr Goodwin, the last witness expected to give evidence, detailed deficiencies in the care of Jones during the 12 months leading up to August 30 last year when Jones hacked to death his flatmate, Mr Beggs, before gassing himself.
Dr Goodwin said there was no doubt Jones suffered from schizophrenia and fulfilled criteria for a diagnosis of antisocial personality disorder. He also had a serious problem with alcohol and cannabis.
From September 1998, after his discharge from the Te Atarau Mental Health Unit at Waitakere Hospital, there was serious fragmentation in Jones' care.
This was not only across teams within Waitemata Health mental health services but across geographical boundaries to Auckland Healthcare, said Dr Goodwin.
In tandem there appeared to be a "clear dilution of responsibility" for the overall coordination and management of Jones' care.
"The overall effect of this appears to have been a lack of appreciation of the longitudinal and enduring risk that Lachlan posed to himself and to others particularly when non-compliant with treatment."
Dr Goodwin said there were a consistent lack of checks that Jones was taking his medication in spite of clear messages that he was not complying.
However, Jones had been a challenging patient, reluctant at times to accept care and minimise his psychotic symptoms.
Earlier, Phil Recordon, a lawyer acting for Mr Beggs' family, questioned a recalled Dr Wayne Miles, Waitemata Health's clinical director of mental health, on whether health workers could pass on information under the Privacy Act about a patient to someone such as a flatmate - someone "providing support whether he knew it or not."
Dr Miles said the Privacy Act was a red herring.
"Your obligation is to ensure what you do is in the best interests of a client or patient. That is the key issue ... It is about ethics and the requirement you have to keep confidential the doctor-patient relationship."
Mr Recordon then called as a witness the Privacy Commissioner, Bruce Slane, who said there would always be dilemmas but health professionals could give information to agencies such as the police if there was a possibility of an offence being committed even if it might not be serious or imminent.
The inquest resumes tomorrow.
'Lack of checks for patient no help'
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