Stuart Clark
2 Apr 2019 · Coroner Philip Spinney · Exeter and Greater Devon
The coroner's concerns
1. vulnerable adult suicide risk
“The evidence revealed that Mr CLARK disclosed to a member of nursing staff on Lowman (Capener) Ward at the Royal Devon and Exeter Hospital that he was a vulnerable adult and a suicide risk. This disclosure was not followed up with an assessment to determine if Mr CLARK had any intent, plan or history of self-harm or suicide. An assessment would have helped determine his risk and inform the decision on a referral to mental health services.”