Inquest becomes aware of miscommunication that stopped look for missing out on James Rugg


The look for a missing out on Banbury healthcare facility client was stopped after the authorities in the West Midlands mistakenly informed Thames Valley Police he ‘d returned house to Coventry.

It emerged that James Rugg had not get back when his partner called the Oxfordshire force the following day to ask what development had actually been made in the look for the missing out on 51- year-old.

The dad-of-two, who was confessed to the Horton Hospital on May 5, 2020, after suffering seizures while at alcohol rehab center Banbury Lodge, was discovered dead in farmland 5 days after he went missing out on from ‘F’ ward.

The night prior to he absconded, an on-call physician taped on his electronic client record – which personnel on ‘F’ ward had actually just begun utilizing when the system was transformed from an orthopaedic injury ward at the start of the pandemic – that Mr Rugg ought to be provided 1-1 care.

Nurses rejected that the medical professional informed them the client ought to get 1-1 care ‘if possible’, although they separately put him on ‘bay watch’ as they were worried about him roaming around the ward. The note about 1-1 care on his electronic client record was not seen by the night nurse and he was not offered 1-1 guidance after the early morning shift began at 7am on May 7.

Mr Rugg’s s partner, Stephanie Mitchell, stated she got a call from him at 9.45 am from the medical facility. “He was really distressed and didn’t understand where he was and desired me to come and get him.”.

Ward clerk Katie Bazely stated in a declaration she had actually called 999 at around 11.30 am to report Mr Rugg missing out on. “The operator asked me if Mr Rugg had capability to leave and I stated yes (due to the fact that this was my understanding from what the nurse had actually informed me). My recollection is that the operator stated that if he had capability then he might make the option to leave however he would contact [his] manager.”.

She passed the phone to deputy sibling Mae Vergara, as she was ‘worried’ about the 999 call handler’s reaction. Ms Vergara stated in a declaration: “I once again revealed my issue and long for them to search for him and make certain that he is safe or go back to the ward.”.

The inquest heard that neither Thames Valley Police nor West Midlands Police had a record of the call, having actually inspected 999 logs around the time the call was apparently made.

A 2nd emergency situation call was made at around 2pm by physicians.

An examination was released and a variety of press appeals provided. Officers were entrusted with inspecting CCTV and taking a look at whether Mr Rugg might have attempted to board a train or drawback a lift back to Coventry.

Oxford Mail:

File picture of Horton Hospital, Banbury

In the early hours of May 8, Thames Valley Police was emailed by West Midlands Police informing them – incorrectly – that he had actually returned house. That mistake – blamed on a miscommunication in between West Midlands Ambulance Service and West Midlands Police – was found later on that early morning, when Mr Rugg’s partner Ms Mitchell called the Oxfordshire force to examine what development had actually been made.

On May 12, officers in a National Police Air Service helicopter discovered Mr Rugg’s body in a ditch in farmland east of Banbury and around 2 miles from the healthcare facility. A post-mortem discovered he passed away of hypothermia and alcoholic ketoacidosis.

An inquest today heard that the helicopter was released on the afternoon of May 12 after a member of the general public called authorities previously that day to report that he ‘d spoken with Mr Rugg 5 days previously.

Supt Emma Garside, now the Thames Valley Police leader for the location, stated she had actually been informed that a demand had actually been produced an aerial search previously however the demand was declined as at the time officers were not able to limit the location that needs to be browsed.

After tape-recording a narrative conclusion, senior coroner Darren Salter stated he would be composing a letter to the National Police Air Service by means of Thames Valley Police flagging the concern of the helicopter resource. He did, nevertheless, identify the air assistance was a ‘limited resource’ in ‘fantastic need’ however stated a letter might show ‘useful, seeking to the future’.

The inquest was informed that a variety of modifications had actually been made by both Oxford University Hospitals NHS Foundation Trust, which had actually enhanced training on electronic record keeping, and Thames Valley Police.

In spite of no lessons being flagged in an Independent Office for Police Conduct report, Supt Garside stated a variety of enhancements had actually been made. They had actually enhanced interactions with the ambulance service, gaining from the miscommunication in between West Midlands ambulance service and cops that resulted in Banbury cops wrongly being informed that Mr Rugg had actually returned house.

The coroner stated a chance was missed on the early morning of May 7 to examine whether Mr Rugg had capability to release himself from medical facility. “If there had actually been 1-1 or closer guidance that in itself would notify a choice about whether a capability evaluation was needed however likewise with closure 1-1 guidance and likewise most likely to have actually avoided the chance to desist or most likely stop James from leaving the health center.”.

Both the coroner and a variety of witnesses kept in mind that the occurrence had actually occurred throughout the very first wave of the coronavirus pandemic, when healthcare facility personnel were getting utilized to various methods of working.

Oxford Mail: James Rugg. Picture: Thames Valley Police

File picture of Mr Rugg Picture: THAMES VALLEY POLICE

Mr Salter concluded that a 999 call was made by ward personnel after Mr Rugg was discovered to have actually left the healthcare facility at around 11 am on May 7. He stated he was ‘less sure’ what was stated by the operator and kept in mind that no record of the call had actually been discovered by either West Midlands or Thames Valley authorities forces.

He stated: “I do not have any proof that this rather brief hold-up if that is what it remained in regards to getting a missing out on individuals examination off the ground is most likely to have actually changed the result.”.

Mr Rugg, a previous senior program supervisor, was explained by his partner Ms Mitchell as an extremely smart Cambridge graduate who spoke a number of languages, was ‘really healthy’ and had actually climbed up Mt Snowdon in North Wales in simply two-and-a-half hours with his 2 kids in the year prior to his death. His alcohol intake had actually increased after losing his task and, after speaking with his household, he had actually examined himself in to Banbury Lodge rehab center.