1 May 2017

Ruby Knox murder case: DHB reveals review details

4:44 pm on 1 May 2017

The health board responsible for the care of Ruby Knox, who was severely autistic and disabled and was murdered by her mother, is set to begin a review of its support services for people with high and complex needs.

Donella Knox in the High Court in Blenheim during sentencing.

Ruby's mother, Donella Knox, in the High Court in Blenheim during her sentencing last December. Photo: RNZ / Tracy Neal

It is the second time since the late 1990s that the Nelson Marlborough District Health Board has reviewed its services after the death of a person with a disability at the hand of a parent.

The board's chief medical officer, Dr Nick Baker, said the circumstances around the 20-year-old's death last year had triggered the latest review.

Ruby's mother, Donella Knox, is serving a four-year jail term for the murder, described by her lawyer as the most tragic case he had dealt with.

Dr Baker said the board had commissioned the review. It would be led by Rosemary Marks, a developmental paediatrician at Starship Children's Hospital, who has been involved with developing national guidelines for the care of people with autism.

The focus would be on how the board might better transition patients to adult care, identify risk when parents or caregivers declined support, and respond to concerns about possible family violence, he said.

Justice Williams said during the sentencing of Ms Knox in the High Court in Blenheim that, despite support from care workers and the medical profession, she felt towards the end that they had abandoned her.

Dr Baker said autism was one of the most challenging conditions to provide care and support for. He said after the sentencing that there were "many unique factors about this tragic event that cannot be publicly disclosed under privacy law".

He told RNZ it was important to ask now if things could have been done better, and that it was "obviously bigger than this one case".

Dr Baker said constantly reviewing services was part of the process for improvement, and too much focus on unique aspects of a single case limited what could be learned.

"In this DHB we have a number of people with very high and challenging needs and they take up a lot of our time. There's a challenge around 'are there ways we might work smarter'," Dr Baker said.

He said improving services that supported the transition from paediatrics to adult care was a priority for both the DHB and the South Island Child Health Alliance.

Previous review

Dr Baker said the call for another review into support services did not reflect a failure to learn lessons from the earlier review.

In late 1998, an inquest found an elderly Nelson woman had taken the life of her intellectually disabled son, and then her own life, because she feared he would be left alone when she died.

Media reports at the time said an independent review of the case, prepared for Nelson Marlborough DHB, recommended that a national strategy be established to ensure adequate care was provided for people like the woman's son.

Dr Baker said most issues that led to a review were complex and benefited from ongoing reviews.

"It would not be anticipated that a single review will solve complex problems such as family violence," he said.

Dr Baker said the forthcoming review would have some features in common with the New Zealand government inquiry into the provision of services for autism conducted by Professor John Werry.

That inquiry took place after the 1997 sentencing of Feilding mother Janine Albury-Thomson, who killed her autistic daughter Casey Albury.

"A number of new initiatives resulted from the review that were then implemented by health boards nationwide," he said.