Coroner warns more patients may die at Newham Mental Health Centre

Senior Coroner for East London Graeme Irvi has warned that more patients may die at the Newham Mental Health Centre unless systemic staffing and supervision failures are addressed.

The warning comes in a Prevention of Future Deaths report issued following an inquest into the killing of Hugo Flint-Cahan, 34. The inquest concluded that Mr Flint-Cahan was unlawfully killed and that neglect by staff contributed to his death.

Mr Flint-Cahan was strangled to death following a beating in the early hours of 3 January 2023. The attack took place on the Topaz ward, an acute unit for men run by the East London NHS Trust.

The inquest revealed a culture of failure among staff on the night of the killing. It was found that personnel slept while on duty, used mobile phones instead of monitoring patients and falsified observation records to suggest patients had been seen when they had not.

Nurses Rosemary Chukwuji-Ohanachum and Raji Olagunju were found to have been in a closed-door staff room. One other staff member reportedly took a two-hour nap in a therapy room during the shift.

The attacker, 22-year-old Rolando Torres-Pena, pleaded guilty to manslaughter on the grounds of diminished responsibility and received a hospital order.

Mr Irvi described the repeated failures at the trust as "Groundhog Day". This is not the first Prevention of Future Deaths report issued to the Newham centre to mitigate similar risks.

The family of Mr Flint-Cahan described the failures in his care as "dangerous".

The East London NHS Trust told the coroner it has addressed some of the issues raised in the inquest and is launching an investigation into the specific staff involved.