Lousia Ovington independent investigation report ... - NHS North East

COMMENT
CHAPTER 2 – EVALUATION OF THE HEALTH CARE AND TREATMENT OF
LOUISA OVINGTON
CAS 1 told the panel that during 2000, Louisa Ovington did not report that alcohol
was a problem to her. However, she acknowledged that as the panel had been
informed by the expert witness Dr E. Gilvarry, it is quite common for people who have
been addicted to drugs to develop problems with alcohol when they cease using
drugs.
Professionals working with Louisa Ovington appeared to be aware that Louisa
Ovington was, at least intermittently, drinking to excess during 2001 to 2003, but she
was not referred back to addictions services until the end of 2003. She admitted to
Consultant 14 on 9 August 2001 that she was drinking two bottles of wine per night
and that she was losing her temper. He gave her the number so she could contact
the addictions services – but it appears that she did not do this. On 14 November
2001, Louisa Ovington told Social Worker 4 that she was drinking “a small amount
of alcohol” but he suspected that she was drinking more than she was admitting
to. In April 2002 she admitted to the “occasional blow out” at weekends. In March
2003, following the transfer of her care from Social Worker 4 to Social Worker 5, she
admitted to drinking excessively and quarrelling a lot with Mr Hilton and in October
that year she told Social Worker 5 that her relationship problems with Mr Hilton
were being exacerbated by her occasional excessive alcohol consumption. However,
she said she did not want help with this. She saw Staff Grade Psychiatrist 1 shortly
afterwards, told him she was consuming 30 units of alcohol per week and accepted
a referral to the Peterlee locality addictions service: Easington Substance Misuse
Initiative (ESMI).
Louisa Ovington attended an appointment with CAS 2 from ESMI in December 2003.
During the initial assessment session, CAS 2 noted Louisa Ovington’s forensic history:
theft, harassment, threatening behaviour and assault occasioning actual bodily harm
on a nurse and she recorded in the brief risk assessment the history of aggression.
Louisa Ovington admitted to her that she was drinking at least 63 units per week. She
said she did not want to achieve abstinence, but she wanted to control her drinking.
She attended two further appointments, but thereafter failed to attend despite having
booked three of four of them herself. CAS 2 wrote to her in March 2004, to ask if
she wanted another appointment. Louisa Ovington did not respond. At around
this time, Louisa Ovington attended an appointment with Staff Grade Psychiatrist 1
and admitted that she was still abusing alcohol, consuming 30 units a week just in
weekend binges. Staff Grade Psychiatrist 1 wrote to CAS 2 informing her of this.
On 10 May 2004 Louisa Ovington presented to casualty in an aggressive and
intoxicated state. She was admitted and underwent an alcohol detoxification process.
She self-discharged five days later. During this brief admission, CAS 2 discharged
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