Thomas Pringle (Donegal, Independent) | Oireachtas source

I want to read in some records on assessments and care plans:

There is evidence that these plans were updated regularly by staff, management and on occasions by a multidisciplinary team however, the contents of the plans rarely changed, nor did Brandon's behaviour change or improve over this period of time, except during periods of ill health... This can be best understood by comparing the first recorded plan for Brandon in November 2003 with the final available plan twelve years later in January 2015.

"All staff need to be aware that Brandon has a history of inappropriate behaviour.. Brandon needs to be supervised at all times by staff... Any untoward behaviour documented..." (Management plan, 20th November 2003).

"Brandon has touched other service users in a sexually inappropriate way... Brandon should not visit other houses... Brandon should not have access to newspapers, magazines and photographs during the day... Brandon is to be supervised when watching TV" (Proactive strategy, January 2015).

In a risk assessment and management plan dated 31st August 2004 the guidance for staff was that they should familiarise themselves with the Health Boards policy "Prevention of Challenging Behaviour" as a means by which to manage Brandon's sexual assaults on other more vulnerable service users. However, there was no evidence that staff were provided with training, at that time, in the implementation of this policy.

Management strategies for Brandon's behaviours

A common management strategy employed to deal with Brandon's sexually assaultive behaviour was to move him around various wards. Brandon was moved a total of nine times in the fifteen year period of this review. The movement of Brandon from ward to ward began on 12th July 2005 when a decision was taken to move him from 'Breaffy to 'Abbeyside' because "Abbeyside would be a safer environment due to (the) level of supervision and male staff available". Brandon was moved to 'Abbeyside' that day, however, due to his level of distress and the fact he wanted to go back to 'Breaffy', he was moved back again that night. Four days later on 16th July 2005 Brandon was then transferred to 'Castledaly'; "transfer to Castledaly due to his nursing care needs - hoist".

On 3rd January 2006 it is recorded that 'Brandon needed an urgent transfer from 'Castledaly' ward'as he was causing major upset to clients, he was subsequently moved from 'Castledaly' back to 'Breaffy' on 2nd February 2006. On 14th June 2007 he was transferred from 'Breaffy' to 'Abbeyside', due to his 'increased aggression towards others. Brandon very difficult to manage...Brandon require(s) male staff 24 hours...Brandon transferred to "Abbeyside" today'.

By December 2008 he was transferred to House 1, in the Stillwater complex. While each of these moves provided some respite to the staff and residents of the ward Brandon was vacating, unfortunately they also gave him access to other residents many of whom became new victims of his abusive behaviour.

At a staff meeting on 4th May 2011, it was also confirmed that a particularly vulnerable resident targeted by Brandon (resident 1) who had no speech and was unable to call out for help had been moved to a different house for his own safety. The decision to move this resident was subsequently reversed five weeks later in a review meeting held on the 9th June 2011 which stated "Resident 1 to return to house 1 in Stillwater because a management plan is in place regarding Brandon's behaviour. The physical environment had been made secure. Alarm applied to bedroom door". The decision to return resident 1 to this unit with Brandon after he had moved for his own safety is very concerning. The review panel believe the assumption the bedroom alarm on Brandon's door would ensure this vulnerable resident's safety is erroneous, as the alarm on Brandon's door had been in place since 30th June 2008 with limited success. In a staff meeting one week later on 15th June 2011 it is recorded: "(it was) acknowledged that Brandon has the capability of opening and closing the door to sound the alarm in an effort to dupe staff"suggesting that Brandon had figured out how to beat the alarm.

Six Month's later on the 22nd December 2011 Brandon was moved to house 2, in the Stillwater complex to live by himself, away from other vulnerable residents. While this move resulted in a sharp reduction in the number of sexual assaults recorded, unfortunately, on 4th September 2013 he was again moved back again to house 1 to live with residents he had previously assaulted.

Brandon's move to house 2 appears to have been the only successful strategy employed in the management of Brandon in that it did provide some protection, albeit short term, to other residents. The reason for Brandon's move back to house 1 was recorded in a "Protection of Vulnerable Adults Strategy Meeting", 19th September 2013.

"...on the 15th August 2013 Brandon became unwell and following this was unable to weight bear and as a result required additional staff to manage his care needs so he was transferred to House 1... It was agreed that due to Brandon's recent deterioration in his health he was no longer able to participate in inappropriate sexual behaviour".

The assessment that Brandon was no longer a risk to others turned out to be inaccurate. According to a document referred to as a "Primary Risk Screening Form" dated 9th September 2015 (two years later) the risks of physical and sexual harm to others from Brandon continue to be identified...

A risk rating scored '25' is the highest risk rating score that can be applied to risks as per the HSE's 'Integrated Risk Management Policy' (2011). On 9th May 2016 Brandon transferred to a nursing home. The nursing home has documented that the reason for Brandon's admission to them is: "Nursing Home) received a request to assess Brandon for long term nursing care in April 2016 from (Stillwater) services. Disclosure was given on an alleged pattern of sexually abusive behaviour and that the transfer was essential because the alleged victim was still resident in the same accommodation as Brandon".

This extract from the nursing home documentation demonstrates that management in the HSE believed Brandon continued to be a risk to other residents in Stillwater and that his abusive behaviour was continuing.

This view is shared by the CHO's Safeguarding and Protection Team's (SPT's) principal social worker who, on 31st October 2017, spoke to the CHO's Chief Officer and said:

"Brandon poses a risk to other vulnerable adults of sexual abuse. Responses to date are that the risk Brandon poses are minimised due to his now limited mobility, however, I do not agree that this is an accurate reflection of the risk as Brandon's behaviours were primarily centred on exposing himself to peers and exposing peers to sexually inappropriate behaviours... Clearly, limited mobility does not minimise the risk of this to an extent whereby other vulnerable adults are protected"...

"The staff at the current environment within the resources available try to limit these incidents which are on-going. If the move to the new house happens now this could reduce the number of these assaults for the most vulnerable group and improve the quality of life for all concerned".

On two occasions psychiatrist (1) also sought a second opinion from other external psychiatrists. The first external opinion was from psychiatrist (2) who reviewed Brandon on 19th March 2008. Psychiatrist (2) brief note states:

"Very difficult management problem...sexualisation probably due to underlying affective disorder...no quality of life due to mental state".

In April 2011 a second external review was sought from a psychiatrist (3) who completed an assessment of Brandon on 12th April 2011. Psychiatrist (3) submitted her report to psychiatrist (1) and service manager (1) on 27th April 2011. This five-page report provides a concise synopsis of what psychiatrist (3) describes as Brandon's "seriously abnormal sexual behaviour". The report outlines two particular problems: "excessive masturbation"and "contact sexual behaviour". The psychiatrist (3) described the residents living with Brandon as "very vulnerable to the sexual threat of opportunistic, predatory and recidivistic approach of this man". Psychiatrist (3) report went on to make a number of recommendations including: - "It is totally inappropriate to allow this man to continue to live with and sexually exploit vulnerable learning disabled men...

-The fact that relatives of his known victims have not been informed of the episodes of abuse could be interpreted as collusion or complicity if the situation were ever the subject of an investigation...".On 4th May 2011 at a staff meeting the issues referred to in the psychiatrist (3) report were discussed and it was concluded that "the residents of house 1 are at risk of sexual advance from Brandon at any time"...

Reports to external managers.

...The first reference of concerns about Brandon being escalated to senior management was in a letter by psychiatrist (1) to his GP dated 7th February 2008 which stated; 'I will be speaking with senior nursing staff in relation to the management of Brandon's behaviour. I will be raising the issues in managing this type of individual within current resources with the local health manager'.

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