Discharge plan had ‘higher chance of failure’

Ian Loughran. Photo: Peter McIntosh

A senior health boss says a Dunedin poet’s hospital discharge treatment had "a higher chance of failure than an ideal plan".

Ian Loughran was found dead at his home on July 19, 2021, aged 55, and this week in the Dunedin District Court, Coroner Mary-Anne Borrowdale is overseeing an inquest into his death.

Yesterday, the inquest heard health professionals were unclear who was "responsible" for overseeing Mr Loughran and his follow-through with the discharge plan.

Mr Loughran was a poet, well-known volunteer and award-winning stand-up comedian.

He read his poems for audiences around the globe and wrote numerous plays, as well as hosting two radio shows.

The inquest will explore six points, including the competency of Mr Loughran’s care and communication between specialists.

Yesterday, the Southern District Health Board medical director at the time, Dr Evan Mason, gave evidence about guidelines and usual procedures for people in Mr Loughran’s situation.

He noted most people would be referred to a community mental health team on discharge, but Mr Loughran refused to engage with its services after his first stay in hospital.

Counsel assisting the coroner Sally Carter asked if Mr Loughran’s unusual discharge treatment plan was likely to fail from the start.

"It had a higher chance of failure than an ideal plan, yes," Dr Mason said.

"Without him agreeing to the whole plan ... and follow-up by the community team then we weren’t able to achieve the best care."

The inquest heard there was uncertainty between health professionals over who was "responsible" for Mr Loughran after his discharge.

Dr Mason said this was "not a delegation, but a shared responsibility" between many staff.

Coroner Borrowdale said that approach left her "unsettled".

"If everyone’s responsible, then in essence maybe nobody is," she said.

"What do we do to ensure that somebody does have eyes on ensuring the patient is getting all the things they are supposed to get?"

Dr Mason said that was a broad question he did not have the answer to.

"Perhaps it’s a philosophical question whether that ought to be the design, but it’s what we have," Coroner Borrowdale said.

A family member of Mr Loughran, who has name suppression, asked Dr Mason about the time it took for Mr Loughran to be followed up in the community after his second discharge.

"It was 11 weeks after Ian was discharged until he saw [a psychiatrist] ... it seems like an unreasonably lengthy period of time," the family member said.

Dr Mason agreed that it was too long.

He said staff were always looking for opportunities to improve systems and deliver the best care for patients.

The inquest is expected to last the rest of the week.