It’s been nearly two years since 19-year-old Kaytlyn Hemsworth died in the psychiatric facility of the Dr. Georges-L.-Dumont Hospital in Moncton.
A three-day coroner’s inquest this week ruled her death a suicide.
“The inquest did not provide the answers our family needed,” said Hemsworth’s mother Sarah in a written statement to CTV News.
Overall, she says her daughter wasn’t portrayed properly during the inquest through the testimonies and she still believes “there needs to be responsibility taken for this devastating tragedy.”
Hemsworth’s death did bring forward seven recommendations aimed at preventing similar deaths in the future – five of which came from the five-person jury and two of which were added by Deputy Coroner Emily Caissie.
The recommendations included:
-Specific staff assigned solely to conduct required patient checks to eliminate lapses caused by multi-tasking or staff shortages
-Adding wearable devices that track vital signs on a continuous bases
-A reduced patient-to-nurse ratio
-Doors and windows should be kept clear of obstructions
-Changes from this incident should be implemented across the entire province
-Nursing stations on psychiatric units should be equipped with a J-knife to facilitate rescue in the event of a hanging situation
-The health authority should put a policy in place to accompany its documentation of surveillance form
Hemsworth’s sister Kalidas says she is happy two additional recommendations were added because it means more protection for patients.
“Definitely the monitoring devices. I 100 per cent think that’s a really cool idea and something I wouldn’t have thought of, but definitely good to monitor their vital signs, when they’re going to have an outburst/panic attack/whatever it is so I really like that suggestion,” she said, noting that having a staff member specifically responsible for checks is another recommendation that really stood out to her.
Hemsworth’s mother would also like to see the health authority implement a proper contact and death notification process as she says it wasn’t handled correctly in her daughter’s case.
Vitalité Health Network said it worked closely with the coroner’s office and fully participated in the investigation process.
“We are committed to carefully reviewing the coroner’s recommendations and remain dedicated to providing a safe and compassionate care environment for all our patients,” said Rino Land, assistant vice president of professional services, in a written statement.
The recommendations have been passed on to the appropriate agencies for consideration and response.
An inquest does not assign blame or make any finding of legal responsibility, but instead aims to make recommendations to prevent similar deaths in the future
“If the recommendations are implemented, I definitely feel that could be effective and it would prevent other deaths like Kaytlyn. One-hundred per cent,” said Kalidas.
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