Checks on killer patient 'superficial'

Police check damage at Colin Moyle's home after he was killed by a psychotic patient. Photo / Herald on Sunday

A leading psychiatrist and the Auckland District Health Board have been criticised for the treatment of a schizophrenic patient who followed through on threats to kill after being released from psychiatric care.

Matthew John Ahlquist was released from the Auckland mental health clinic Te Whetu Tawera in March 2007, despite threatening to kill staff and having a history of violence.

A few weeks later he threw boiling water on Colin Moyle, 55, bashed him with a spade and set him on fire at Mr Moyle's Auckland home because he thought he was "demonic".

Two psychiatrists later diagnosed Ahlquist with paranoid schizophrenia and he was found not guilty of murder on the grounds of insanity.

He is now in the Mason Clinic, a secure psychiatric hospital, as a special patient.

Now a Health and Disability Commissioner inquiry has criticised the care provided by Dr Thom Rudegeair, the former head of Te Whetu Tawera, and the Auckland DHB.

The Weekend Herald has obtained an uncensored copy of the report which says Dr Rudegeair's risk assessment of Ahlquist was superficial and incomplete and failed to identify his "mental health was unravelling".

Commissioner Anthony Hill concluded the Auckland DHB did not have appropriate checks and balances, and system failures led to inadequate communication, discharge planning and follow-up care.

The inquiry relied on the advice of independent expert psychiatrist Dr Nick Judson, who said it was clear the management of Ahlquist was complex and challenging.

But Dr Judson was concerned with the clinical assessment of Ahlquist on his admission to the unit in March 2007, which he said appeared to discount the possibility of psychosis.

"This led to the development of a treatment plan that was appropriate for what Dr Rudegeair assessed to be Mr Ahlquist's need, but was ultimately unhelpful."

Dr Judson said Dr Rudegeair's assessment of Ahlquist's risk was superficial and did not try to explore some of the more obvious indicators such as verbal threats of violence.

"The decision to discharge Matthew without any clear or effective plan of follow-up, into an environment in which it was likely that his psychosis would deteriorate, was inappropriate.

"This in my view was a moderate to severe departure from an accepted standard."

Dr Rudegeair resigned from Te Whetu Tawera in April 2008, and is now a consultant psychiatrist at the St Lukes Community Mental Health Centre.

He championed the "recovery concept" - which aims to help patients regain control of their lives - which some of his colleagues disagreed with for the treatment of acute patients.

Dr Rudegeair told the inquiry he was concerned about being "unreasonably singled out for investigation and criticism.

"I am not prepared to accept the inference that is conveyed by your provisional opinion that I was solely responsible for those decisions, or that my initial plan somehow adversely affected the care provided to Mr Ahlquist."

He said Ahlquist was not considered a high-risk patient at the time of his discharge.

He said there was no evidence that Ahlquist was delusional or hostile - two elements in his previous violent behaviour - for six months before the discharge.

"Dr Rudegeair stated that, in his opinion, the attack on Mr Moyle was an unpredictable event," the report said.

The Auckland DHB told the inquiry that structural, management and practice changes has been made in the past three years to make mental health care and discharge planning "significantly more robust".

Since the age of 21, Ahlquist had received psychiatric treatment after being diagnosed with schizophrenia, aggravated by serious head injuries from a skateboard accident, and by drugs and alcohol.

By 2004, Ahlquist had a high level of resentment towards his father. In 2005 an unprovoked Ahlquist tried to strangle his father in the family's kitchen, knocking his mother over and kicking her when she intervened.

Both parents were hospitalised, but only a minor charge of common assault was laid by police.

A mental health worker wrote to the Auckland District Court with his concerns that Ahlquist could not be treated in the community and should be committed to the Mason Clinic.

"Mr and Mrs Ahlquist are now understandably fearful of Matthew ... We feel the risk to Matthew's father will rise to an unacceptable level if Matthew is discharged into the community."

It is not known if the judge ever saw the letter.

No one from Auckland DHB mental health services appeared to testify in court. Instead of being committed to the Mason Clinic for secure treatment, Ahlquist was released.

During that time, he assaulted an unknown man and threatened to kill his psychiatrist and Dr Rudegeair.

It was recommended Ahlquist should be committed to the Mason Clinic - again there was no room.

An administration error meant a compulsory treatment order for Ahlquist lapsed in July 2006 and was not renewed.

This meant Ahlquist could now refuse antipsychotic drugs treatment - this was outside the scope of the Health and Disability Commissioner's inquiry but was labelled "unsatisfactory".

By March 2007, Ahlquist was readmitted to Te Whetu Tawera where staff considered compulsorily detaining him.

He told staff he wanted to kill somebody, but then became guarded, insisting he made the statement because he was "off his head on painkillers".

He was admitted informally but was not diagnosed as being psychotic and was discharged 12 days later after getting drunk in the ward.

Ahlquist's family expressed their anger at the "inappropriate discharge".

A few weeks later Mr Moyle was dead.

Review details bad judgment
The killing of Colin Moyle was one of four cases at Te Whetu Tawera investigated in an external review headed by Dunedin psychiatrist Stephanie du Fresne.

The others were the suicide of a man in an open ward, the apparent suicide of a man and the death of a patient admitted to the intensive care unit.

The review team also considered two other cases. They concluded that all six showed "unacceptably poor clinical judgment and practice" by some staff. The du Fresne report revealed a string of errors in Ahlquist's care, and doctors' disagreement over his release.

Victim's son finds not-guilty verdict hard to accept
Deane Moyle finds it hard to accept that the man who killed his father was found not guilty of murder because he was insane.

Blaming anyone other than Matthew Ahlquist was wrong, said Mr Moyle. But he was compelled to ask the Health and Disability Commissioner to investigate the circumstances that led to Ahlquist being in the community when he was "clearly unwell".

He said the Auckland District Health Board had made substantial change in mental health care as a result of internal and external reviews.

"This has to be a good thing," he said.

But the Moyle family say Dr Thom Rudegeair has not acknowledged his part in the failings in the care given to Ahlquist.

"We expect he never will. The consolation we have is that he is no longer in a position to make clinical decisions that put the public at risk."