NHS apology over death crash pair

Leicestershire Partnership NHS Trust apologised for below-standard care of a mentally-ill woman
12 April 2012

An NHS Trust has apologised unreservedly for below-standard care of a mentally-ill woman who ran over a mother and daughter, leaving them dead.

Gemma Montanaro was suffering hallucinations when she lost control of her car on January 30, 2007 on Saffron Lane, Leicester. She hit mother and daughter Jane Ann Malkin and Nichole Townsend, killing both of them.

Miss Montanaro told police that Satan had been behind the wheel of the car.

She was later cleared of causing death by dangerous driving "by reason of insanity" but was banned for driving from life and given a court order under the Mental Health Act.

An independent report found that although the tragedy could not have been predicted or prevented, there was a "lapse in safe standards of care" on the night before the accident.

The report, which referred to her only as the Mental Health Service User (MHSU), said on January 29, 2007, after a deterioration in her mental health, she was assessed in A&E by a Deliberate Self Harm team and then a Crisis Resolution and Home Treatment Team, who decided she was suitable for home treatment.

But it found although home treatment was appropriate, she was accepted without an adequate plan in place, and should not have been sent home as she was. The report said the fact no "interim care package" was implemented showed a "lapse in safe standards of care".

It made nine recommendations - eight for Leicestershire Partnership NHS Trust and one for NHS East Midlands, which commissioned the report.

Antony Sheehan, chief executive of the Leicestershire Partnership NHS Trust, said: "The standard of care offered was not adequate, it was not up to standard, it was not what should have been expected by people using these services. The consequences were tragic and I want to offer a full apology for this to the families who have lost loved ones.

"Safeguarding members of the public and providing safe and supportive services for our patients are our most important priorities but regrettably, on this occasion, we failed to meet these standards. We therefore let the service user down and for this she deserves our unreserved apology."

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