Mother of Limerick man who drowned hits out at HSE mental health services at inquest

AN ANGUISHED mother has criticised the HSE for “excluding” her from the treatment of her son, who died by drowning one day after he was presented to mental health services “in crisis”.

Derek Cosgrove, 30, of Coolraine Heights, Clareview, was pronounced dead on January 9, 2017 after he was seen entering the River Shannon on December 16, 2016, an inquest into his death has heard.

The hearing at Limerick Coroner’s Court, which lasted more than five hours, heard that the father-of-one had been a “frequent user” of mental health services since 2013.

Retired consultant psychiatrist, Dr Patrick Doyle said that Derek had suffered from drug-induced psychosis, “major depression” and was hearing “voices”. 

The inquest heard that Derek “smoked cannabis occasionally”.

Reading her garda deposition last Thursday, Ms Cosgrove said that she and Derek attended Tevere House, a day hospital on Shelbourne Road, on December 15. She said she felt “he was in crisis” and was told at Tevere House that he was “unwell as a result of side effects of new medication he was taking” since December 7.

The inquest heard that Derek was prescribed Provigil for “concentration issues” on December 6, but stopped taking the drug after three days.

Dr Noreen Moloney, who met with Derek on December 15, described him as a “courteous, polite gentleman who spoke in a low, monotone voice”.

She said that he had been suffering from a “depressive episode” and that he “denied suicide ideation and expressed hope for the future”.

She said it was “reasonable that he was treated on an outpatient basis” after Ms Cosgrove queried the need for admission.

The inquest heard that Derek had been suffering from a lack of sleep.

Ms Cosgrove said: “Derek was told if he did not sleep that night to come back the following day”.

The inquest heard that Ms Cosgrove said that her son was experiencing “auditory hallucinations”. Dr Moloney said that when she asked him if he was experiencing this, he replied that he wasn’t.

It was heard that Derek, at one time, was on four different types of medication, including lithium and ativan.

Mr D’Arcy said Derek’s condition had “vacillated”. On March 10, 2016, his mood was stable and “had no thoughts of self-harm”.

On March 18, he was “feeling suicidal”. Dr Doyle said Derek’s condition would have depended on his compliance of medication and use of cannabis. He added that Derek was seen “cheeking” medication.

“That is news to me,” Mr D’Arcy replied. Ms Watret said the “spitting out of medication” was in the medical records.

On March 25, his condition was described as stable. In May 2016, Derek was prescribed ativan, which is used for anxiety relief, the inquest heard.

Derek, who started on lithium in January 2016, had the prescription increased that May, the inquest was told. Mr D’Arcy asked why lithium was increased following a period of two months when his treatment was “going well”. Dr Doyle said that this was in order “to reach therapeutic levels”.

On June 3, 2016, his ativan was decreased after he was “sleeping poorly”.

“He had been on a high dose of ativan, and we didn’t want him to be dependant on it,” Dr Doyle said. It reduced again on June 17.

In October 2016, it appeared that life was “beginning to stabilise for him”. However, Derek complained of a “lack of feeling” on lithium and that he “didn’t want anything from the periodic table”, the inquest heard. 

Dr Doyle said that Derek was “warned of the risk” of completely coming off lithium, and that the doctor was “tailing it off”.

Mr D’Arcy asked Dr Doyle what it means when someone “doesn’t want anything from the periodic table”. Dr Doyle replied: “I am not sure, really, what it means. It means, to me, that he has a lack of insight into his illness.”

The retired psychiatrist added: “What was happening here, Derek was feeling well. And when people feel well, they want to stop the medication. They think that they are cured.”

In November 2016, Derek’s condition was described as “stable”.

Dr Doyle said that he was “happy with Derek’s mental state at the time” after December 6.

According to Ms Cosgrove’s garda deposition, Derek was “tormented for most of the day” on December 15.

“He came into me at 4am and asked for a sleeping tablet and I gave him one of my own. Derek said he felt a little better and would get some sleep,” she said.

At around 9.30am on December 16, Derek said he was “going for a walk to clear his head. It was a beautiful morning and when he left, everything seemed normal”.

She said she “started to get worried after a while” and that she had “no way of ringing Derek”.

“I heard then in the news soon after that a man had jumped in the Shannon River during the morning.”

She said she was contacted by gardai on January 9 after his body was located.

“Just to confirm, when Derek came into my room at 4am, I told him we need to go back to Tevere House in the morning. He then said: ‘No mum, I feel a bit better’ and that he had got some sleep.”

Gda Conor Cronin said that Derek was pronounced dead by Dr Seamus Kilby at 3.25pm on January 9, 2017.

Pathologist Dr Terezia Laslo said the cause of death was drowning.

Coroner John McNamara described Ms Cosgrove’s speech as “anguished and heartfelt”. Sitting next to the framed picture of her son after all the evidence was delivered, she said: “This was my beautiful Derek.

“I will never see my beautiful son again. He was a gentle soul who never raised his voice. He was a chef, an entertainer, and intellectually-gifted.

“He was proud of his family and friends. He was loved and nurtured. He didn’t want to die. He just wanted to sleep.”

Addressing Dr Doyle, she said: “I remember you talking to me, Dr Doyle, and you said: ‘I will get Derek back.’ And I think we did.”

She said he celebrated his 30th birthday in May 2016. “It was a big one because he was trying to change his life,” adding that in October, he had started dating.

Ms Cosgrove said that during her meeting with Dr Moloney on December 15, she claimed she was “never looked at” while she took notes.

Ms Watret said Dr Moloney “refutes that she was rude or dismissive”. The coroner noted that there was “a conflict of evidence”.

Speaking about leaving Tevere House, she said: “I don’t know what happened. I keep trying to work out the what-ifs. Every time I went, in crisis, he was admitted. This was different.”

She claimed that she “not aware of the medications being changed” and that she was “not aware of the side-effects”.

“Derek never excluded me. Ye excluded me,” she said.

Concluding, she said: “There is a culture of never owning up to our mistakes in society. Atrocities are happening here in Ireland at the moment...Limerick city has the highest rate of suicide in Ireland. In 20 years, when we look back, where will we place the blame?”

Ms Watret said: “You have heard Dr Moloney’s evidence. I just want to say that Mr Cosgrove was a frequent user of the mental health services on an inpatient, outpatient and crisis basis.”

She said that an “appropriate plan was put in place” by Dr Moloney. 

“On behalf of the HSE, I would like to express my condolences to the family of their beautiful son, Derek.”

Mr McNamara asked what the position is with clinicians discussing patient care with extended family members.

An HSE official replied: “It’s quite tied up in legislation and human rights. If you are an adult with capacity, you are entitled to your privacy.”

The coroner said that Dr Moloney made a judgement call and put a plan in place, and that there was “no indication of a risk of suicide ideation”.

Recording an “open verdict”, he said he was “not confident” to record Derek’s death as suicide and that he “certainly seemed to be on the right path in 2016”.

“I appreciate how difficult it is for you, Majella. You would have to be made of stone to not be affected by your words.”