Royal hoax phone call inquest: Nurse 'took own life'
A nurse who put through a hoax phone call at a hospital where the Duchess of Cambridge was being treated took her own life, a coroner has concluded.
Jacintha Saldanha, 46, was found dead on 7 December 2012, days after taking the call from two Australian radio DJs.
Coroner Fiona Wilcox said the call was "clearly pressing on her mind" but she had had "appropriate" support.
The duchess was being treated for morning sickness at King Edward VII's Hospital during her first pregnancy.
John Lofthouse, the London hospital's chief executive at the time, told an inquest that Mrs Saldanha was widely regarded as being caring, compassionate and committed to her role and the hospital.
Asked by Dr Wilcox how the senior management team viewed the incident, he said: "We spent some time discussing it and it was our view that the nurses were the victims of a prank.
"There were some people in the senior management team who felt they breached confidentiality and should be dealt with by disciplinary measures.
"My own view and that of the matron and deputy matron was that the hoax had put them in a very difficult position and they should be treated as victims."
Mr Lofthouse said the protocol for nurses was to take the details of the caller then put the phone down and pass the details on for another member of staff to verify.
He said: "The protocol is very clear, it doesn't matter who the person on the end of the phone is or pretends to be, you follow that protocol."
"I believe people in that role [answering calls] had had very good training on a one-to-one basis from the night superintendent. But Jacintha Saldanha, despite that training, had made a mistake. So we needed to strengthen the training arrangements."
The court heard that Mrs Saldanha later left a message on the HR telephone saying she would not attend a training day.
Mr Lofthouse said he listened to the voicemail several times "to see if there was anything in her tone, any indication of her being upset or wavering and there simply wasn't".
He told the inquest: "We all regarded her as a very well-balanced robust stable individual. Her death took us all by shock by enormous surprise."
Mr Lofthouse said Mrs Saldanha appeared "embarrassed" when a small number of staff wished the Duchess of Cambridge well in the matron's office when she was discharged on 6 December.
Mrs Saldanha was the first nurse to answer a call by DJs Mel Greig and Michael Christian, who imitated the Queen.
She passed them to a second nurse on the duchess's ward who gave out details of her medical condition.
John Cooper QC, representing Mrs Saldanha's family, asked to whom she should have referred the call.
Mr Lofthouse replied: "There were people within the hospital who were well placed to provide reassurance or otherwise about whether a telephone call was genuine."
He said if Mrs Saldanha had wanted any further advice, a matron lived in an apartment in the hospital and he was on call 24 hours a day.
Det Con Will Richards, a member of the police investigation team, told the inquest initial investigations suggested it had been a suicide.
The inquest had earlier heard that Mrs Saldanha blamed herself for putting the call through and was "very upset".
Summing up, the coroner said four further calls made by the radio station were almost certainly received by Mrs Saldanha.
She said: "I find it inconceivable that she would have consented as a participant in the [hoax] call to its broadcast."
The coroner said there was no disciplinary action, just support for the nurses, and the incident was treated as a learning experience.
Dr Wilcox said three notes that were found "together provide evidence of intention to take her own life".
"The hoax call was clearly pressing on her mind as were the difficulties she had expressed about a colleague," she said.
"This incident was not reasonably foreseeable. The support given was reasonable and appropriate."'
After the coroner had given her conclusion, Ms Greig said through her lawyer that she wished to make a statement.
In tears, she apologised to Mrs Saldanha's family and to the other nurse, saying: "This tragedy is always going to stay with me as a constant reminder."
Ms Greig was in court for a second day despite not being called as a witness.
MP Keith Vaz, speaking outside court on behalf of the family, said they were taking advice over possible future legal action.
"Over the last two days, the family and the world have heard about her nobility, her dedication to her patients, her love of her job and her fantastic professionalism," he said.
"The family of course accept the verdict of the coroner's court today. These despicable and cruel actions, this hoax, has changed their lives forever."
Westminster Coroners' Court was sitting at the Royal Courts of Justice for the two-day hearing.