Rough sleeper 'failed by the system' following premature hospital discharge, inquest hears

A rough sleeper who died just days after he was ‘inappropriately’ discharged from hospital was ‘failed by the system that should have protected him’, an inquest has heard.

Wayne Merchant, 51, spent five days at Wexham Park Hospital in May 2023 to undergo treatment for a suspected perforated ulcer in his abdomen.

Despite concerns over his physical and mental capacity, the decision was taken to discharge Mr Merchant from hospital on Friday, May 19.

He died four days later, with a member of the public discovering his body in Slough.

An inquest into the homeless man’s death got underway at Reading Town Hall on Tuesday, which will explore how he came to be discharged from hospital.

A family tribute to Mr Merchant described him as a ‘free spirit’ who had battled mental health difficulties since a young age.

He held a deep passion for trainspotting and had an encyclopaedic knowledge of Premier League football club, Tottenham Hotspur.

“Whatever his struggles in life, sport was his great escape,” a family tribute said.

“We are here today not only because of Wayne’s death but because it appears he was failed by the system that should have protected him.

“We hope no other family will have to go through the same tragedy that we have endured.”

The inquest heard how Mr Merchant was admitted to Wexham Park on May 15 after he had been suffering from a perforated ulcer in his abdomen.

He was admitted to the hospital’s surgical ward, where his care was initially overseen by consultant surgeon Dr Francis D’Souza.

Dr D’Souza said Mr Merchant was suffering from two stomach ulcers, one of which was likely to have happened 10 days ago and was already healing.

But during his time on the ward, Dr D’Souza explained how the 51-year-old regularly refused treatment.

This meant daily blood tests could not be taken, important medication to reduce acid levels in the stomach could not be administered and he continued to eat and drink against doctors' advice.

The inquest heard how medical staff were only able to administer two doses of antibiotics with six doses missed.

Dr D’Souza described his mental capacity as ‘fluctuating’ and said the decision was taken to ‘conservatively manage’ his treatment rather than choosing more aggressive treatment options, which could have involved sedation.

The inquest was told how on the morning of Friday, May 19, Dr D’Souza handed over the care of Mr Merchant to Dr Ihsan Al-Shoek, a consultant general surgeon at Wexham Park Hospital.

Dr D'Souza told the inquest that he would not hand over a patient's care if he thought they were ready for discharge and was anticipating 'a few more days at least' of care.

But following the morning ward round, where the clinical team reviews each patient’s status, Dr Al-Shoek took the decision to discharge Mr Merchant.

Dr Junzheng Wang, a foundation year doctor who was working as an on-call doctor in the surgical department on the day of Mr Merchant’s discharge, told the inquest: “My understanding was that from the end of the bed, he appeared to be mentally and physically improved from what he came in with.

“I would guess that would be the rationale (for the decision).

“I was not involved in that decision.”

Dr Wang’s role included finalising the paperwork for Mr Merchant’s discharge.

The inquest heard how during this process, he became aware of a medical note by Dr Priya Anand, clinical psychiatrist, which said a mental health assessment of the patient needed to take place before he was discharged.

The junior doctor told the inquest he spoke to Dr Al-Shoek about this but was advised that the discharge should still go ahead.

Catherine Rabiothi, representing Dr Al-Shoek, questioned whether this conversation had taken place.

She told the inquest: “Are you sure there was a conversation in relation to Dr Anand’s review?

“What you discussed with Mr Al-Shoek wasn’t Dr Anand’s review but issues regarding Wayne Merchant’s housing situation.”

Mr Merchant was discharged from the hospital at 5.30pm and did not return.

A pathology report found that one of Mr Merchant's stomach ulcers had haemorrhaged with half a litre of blood discovered in his abdomen.

The inquest heard that the Frimley Health NHS Foundation Trust, which runs Wexham Park, admits the decision to discharge Mr Merchant contributed to his death.

The inquest continues.