SINGAPORE — A worker found lying at the third floor staircase landing of Khoo Teck Puat Hospital (KTPH) earlier this year was found to have committed a deliberate act of suicide, the State Coroner ruled on Friday (25 September).
“I also acknowledge that assessment of suicide risk is extremely difficult. In this instance, Mr Alagu did not demonstrate behaviour that suggested suicidal intent,” State Coroner Kamala Ponnampalam said on Alagu Periyakaruppan’s death on 23 April this year.
Alagu, a 46-year-old Indian national, had been diagnosed with COVID-19 and warded in KTPH when he prised open a window panel beside his bed, slipped out, and fell four storeys to his death. He was found directly in line with the window which he fell out of. Despite resuscitation efforts, he was pronounced dead at 7.15am.
Just two days before his suicide, Alagu mentioned in a phone conversation to his nephew that the younger man would have to take care of Alagu’s family. Alagu had told Veerappan Meenakshi Sundram, 24, to provide a “good education” to the latter’s brother.
The nephew felt that something was amiss as his uncle had not spoken that way before. When Meenakshi tried to probe further, Alagu did not elaborate. The nephew ended the conversation by reassuring his uncle that he would recover soon.
To the hospital staff, Alagu had not presented any behaviour that showed him to be a suicidal risk. He was noted to have interacted appropriately with staff and patients and was described as “quiet, pleasant and helpful”. He had also assisted to serve food to other patients during mealtimes.
The only time he verbalised his concern was to his attending consultant, to whom he expressed his worries about his children and financial position.
The construction worker made two self-recordings in his ward’s toilet around an hour before his death, expressing his wish to end his life as he had been informed about his COVID-19 infection. He added that no one had anything to do with his decision and that he arrived at it with a sober mind.
Using a metal hook, Alagu turned to the window beside his bed to prise out the windowpane holders, Alagu then slid out the glass pane from its slot. He placed the glass pane on the floor. He then fell to his death.
His absence was only discovered by a staff nurse who was about to conduct her morning rounds at around 6.15am when she heard a thud from Alagu’s ward. Upon her investigation, she found Alagu missing from the ward and alerted her colleagues.
Another nurse who was working the night shift had heard the patient call bell from Alagu’s bed at about 1.39am. When a colleague attended to Alagu, she found him covered with his blanket and he was silent. The nurse thought that he might have pressed the bell by mistake.
The only other patient in Alagu’s ward had been admitted together with him since 19 April. The two, which were a bed apart, barely spoke to each other due to language barriers.
The patient noticed Alagu using his mobile phone on 22 April. The patient then slept through the night after taking cough medication and did not hear any thud.
Goh Kah Hong, Head and Senior Consultant of Psychological Medicine at KTPH, who chaired a committee reviewing the incident, found that there was no lapse in the hospital’s clinical care.
The doctor found that many COVID-19 patients did not have a good understanding of the virus. Following the incident, a workgroup was formed in KTPH to look into the welfare of foreign worker patients.
The hospital has also provided additional resources to these patients such as video recordings about COVID-19.
It has also taken steps to reduce fear and the feeling of isolation like providing chargers and top-up cards for mobile phones of these patients so that they can stay connected with their friends and family. Nurses also made it a point to connect with patients and had their names written on their personal protective equipment.
Following this incident, a review was conducted by KTPH’s Safety Committee and a decision was made to apply silicon to the plastic holders for all windowpanes in the hospital, to prevent them from being easily removed.
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