Two people die as HSE shuts rehab unit

Two people died weeks after the HSE closed down a rehab unit for ‘high-risk’ clients, despite warnings of ‘suicidal ideation and death’ if it did shut.

The Keltoi centre in Dublin’s Phoenix Park was a rehabilitation unit up to March, but was shut during the pandemic ‘without any consultation or planning’, correspondence obtained by the Mail shows.

A damning internal letter, on May 27, shows how assessments had repeatedly warned of a ‘major risk’, with death being an ‘almost certain’ risk. And the parents of one man who died told how his death had devastated them, and said it could have been prevented – while a HSE whistleblower told the Irish Daily Mail that the deaths were ‘avoidable’.

When the pandemic hit, Keltoi became a centre for Covid-19 patients, and the whistleblower has said those struggling with addiction were left without support.

A risk assessment sent to HSE managers on March 6 warned of the risk of ‘overdose, self-harm, suicidal ideation and death’ if the facility was closed. It received the highest possible risk rating.

Another serious risk warning was sent on March 9. The centre closed on a staggered basis throughout March and fully closed on March 20.

The man and woman who died were both living in Dublin, and they died within days of each other, just a number weeks after the centre closed.

The man, in his 40s, died in his family home seven weeks after the service was closed.

His parents told the Mail they believe their son ‘would still be alive today’ if the facility had remained open.

The woman who died was a mother of one, also in her 40s. Both were identified by staff as being ‘particularly at risk’ when the facility closed. The HSE whistleblower, who contacted this newspaper, said: ‘People do die in recovery but this was definitely avoidable and manageable.

‘Both of these people were circled as being particularly at risk when they were being sent out into the community and they were left with no supports to help them.’ The Keltoi facility was closed ‘without consultation’ and repurposed to provide 18 isolation beds for Covid positive patients, who could not isolate in their own homes. Questions have been raised about the decision to close the service and use the facility to bring vulnerable people with coronavirus onto the campus.

The facility is on the same grounds as the St Mary’s Hospital nursing home, where 24 residents have died from the virus. At the same time, the HSE is paying €25million to rent the 750-bed Citywest Hotel in Dublin, which is ‘practically empty’, with just 33 patients there last week, according to the latest figures from the HSE.

The Mail has seen an internal letter, sent to two high-ranking HSE officials, from the Clinical Quality and Safety Committee (CQSC), which is made up of 16 addiction specialists.

The letter was sent in the aftermath of the two deaths and it outlined that the risk assessments show these deaths were ‘almost certain’.

‘Regrettably, two service users from that last service user cohort in Keltoi have subsequently died from suspected drug overdoses (April/ May 2020). This risk to service users was rated as being a “Major Risk” which was “Almost Certain” in the Risk Assessment process,’ it said.

‘This closure was implemented by Addiction Service/ Social Inclusion management without any consultation or planning with the Keltoi clinical manager or other clinical stakeholders, despite the unit being fully operational at the time.’ The letter pleaded for the reinstatement of the facility ‘as soon as possible’. The whistleblower said that staff in Keltoi were ‘devastated’ when they learned of the two deaths and felt they were constrained from continuing to help clients when they were repurposed to different parts of the health service to deal with Covid-19.

Sinn Féin health spokeswoman Louise O’Reilly told the Mail: ‘The Minister [for Health, Simon Harris] needs to examine why the risk assessments were ignored and why vulnerable people were transferred back into the community without adequate supports. We need to know that other risk assessments haven’t been ignored. It beggars belief that we have a facility in Citywest that is practically empty, that we are paying €25million for, and the decision was made to close a facility for the most vulnerable people in our society.’ A HSE spokeswoman said all clients had completed their residential treatment when the facility closed. However, the whistleblower pointed out that the care pathway lasts for around two years, and that clients would normally be put into a day programme, and would continue one-on-one counselling and attend Narcotics Anonymous.

The staff members who were providing care for them were repurposed to other roles, meaning they could not keep in contact with the vulnerable clients.

The internal HSE letter of May 27 from addiction specialists noted: ‘There are no alternative care pathways available which can manage this level of complexity…’ It also said: ‘The Keltoi unit was closed, with no clarity or commitment provided regarding reopening…’ It added: ‘However, the impact of this on the Addiction Service has been that extremely vulnerable drug users with severe addiction and acute clinical needs who wish to safely detox are unable to access residential detoxification and rehabilitation appropriate to their needs.’ A spokeswoman for the HSE said it was not in a position to comment about the deaths.

‘As the confidentiality of our patients is a priority, the HSE is not in a position to comment on individual cases in order to protect this,’ she said.

‘Keltoi was not at full capacity prior to being repurposed for use as part of the response to Covid-19. However, all residents had completed their residential rehabilitation programme before Keltoi closed, and had been offered aftercare supports.

‘The aftercare programme had previously moved to the HSE Stanhope Centre in Dublin 7. This programme has continued to operate since the residential programme closed, through online sessions. Also additional health and social supports, including consultant psychiatrist support, are provided as required.’