NHS staff slept and falsified records as patient was killed — SkimNews
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- Hugo Flint-Cahan, 34, was strangled by fellow patient Rolando Torres-Pena at Newham Mental Health Centre on 3 January 2023; the coroner returned a narrative conclusion of unlawfully killed contributed to by neglect and recommended four staff be referred to their regulator.
- Two nurses and a nursing assistant on duty on Topaz ward — Rosemary Chukwuji-Ohanachum, Raji Olagunju and Anthony Onuh — were shut in the staff room or asleep for two hours in the therapy room while CCTV showed no staff visible when a neighbouring patient peered out, apparently disturbed by the attack.
- Observation records were falsified, with Onuh admitting he filled out the 02:00 log showing Hugo was "in his bed awake" without checking on patients; Hugo was not discovered until 03:19, CPR did not begin until 03:45 and he was declared dead at 04:41.
- Senior Coroner Graeme Irvine compared the case to "ground hog day," citing repeated identical failures, and asked the Metropolitan Police to review their investigation into the night in question.
- The East London NHS Foundation Trust has received at least 29 Prevention of Future Deaths notices from local coroners over the past 12 years, with falsified observation records and poor emergency response repeatedly flagged; a 2021 report had already warned of "a culture of impunity" at the Trust.
- Torres-Pena, 22, pleaded guilty to manslaughter on grounds of diminished responsibility at the Old Bailey and was given a hospital order without time limit.
Why it matters: The East London NHS Trust has received at least 29 Prevention of Future Deaths notices over 12 years with the same failures repeatedly flagged — falsified observations and slow emergency response. Four staff have been referred to their regulator, and charity Rethink is calling for a national patient-safety register to address what the coroner called "ground hog day" failures.
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