Doctor did not believe triple killer was delusional

A doctor who examined a man less than 24 hours before he went on to kill three elderly men during a psychotic episode concluded, after a 15-minute assessment, that he was not delusional, an inquest has heard.

Alexander Lewis-Ranwell, now 35, was arrested and released twice in the days before he killed Anthony Payne, 80, and twins Roger and Dick Carter, 84 in Exeter on 10 February 2019.

An inquest into their deaths heard police officers, health workers and Lewis-Ranwell's mother all rasied concerns about his mental health during his two periods in custody from 8 February.

Dr Mihail Pichiu denied he failed to act on "warning signs" Lewis-Ranwell was seriously unwell.

The inquest heard one custody officer described Lewis-Ranwell as "one of the most mentally unwell individuals I can remember encountering" and said he could "hardly believe it" when Pichiu told him he did not require a Mental Health Act assessment (MHAA), which could have resulted in him being sectioned.

Jurors at the hearing in County Hall in Exeter heard Pichiu arrived at Barnstaple police station at about 18:15 on 9 February.

Pichiu, who trained in Romania before moving to work in UK hospitals, had been working as a forensic medical examiner for G4S providing medical services to Devon and Cornwall Police since 2017.

The inquest heard Pichiu determined Lewis-Ranwell had "no acute medical conditions" and noted, "For L&D in the AM" - meaning he should be seen by Devon Partnership Trust's Liaison and Diversion (L&D) service.

The inquest heard he concluded Lewis-Ranwell was not suicidal or delusional and rang the duty Approved Mental Health Professional (AMHP), whose job it is to coordinate MHAA assessments, to discuss the case.

In his notes from that call, Pichiu wrote the AHMP had advised him "if not suicidal or delusional", Lewis-Ranwell was not appropriate for a MHAA.

Nick Armstrong KC, representing the Payne and Carter families, said there had been a consensus view from custody officers and a mental health nurse that Lewis-Ranwell required a MHAA and that Pichiu had stopped it.

Pichiu said in the inquest: "I haven't stopped it.

"He was not an immediate risk; he was in a place of safety. He was not a risk to others because he was in a place of safety."

Armstrong also questioned whether Pichiu had received mental health-specific training during his employment with G4S because his training log did not show anything.

Pichiu said he would have done during his induction.

Counsel to the inquest Andrew O'Connor asked about comments made by Lewis-Ranwell during the examination, including that the police had done something to his blood and his food had been tampered with.

Pichiu said in response it could potentially be delusional and "they have been noted".

He said: "Yes I can see his behaviour is, by all means, not normal.

"There are concerns, not necessarily throughout my exam but there are concerns raised by others."

Asked if he considered the risk Lewis-Ranwell posed to others, knowing he had been arrested on suspicion of GBH after attacking a man, Pichiu said he asked Lewis-Ranwell if he was planning to do any harm to himself or others.

"In his case, he denied," Pichiu said.

O'Connor asked what else Pichiu had done to consider the risk to others.

Pichiu said: "That would be an assessment that's not for me to make."

O'Connor said: "Are you saying it was beyond your competence to explore any further?"

Pichiu said it was.

O'Connor suggested it was not Pichiu's role to reach a diagnosis but to "determine if there were warning signs", warning signs he had seen but not acted on.

Pichiu told the hearing it was not correct saying he did not act as he had safeguarded Lewis-Ranwell who was in a place of safety and discussed the case with the AMHP.

The inquest previously heard evidence from Alan Harness, then a healthcare technician for G4S based at Barnstaple police station.

Harness told jurors Pichiu was abrupt and appeared to be "fed up being here" and there was a general feeling of "surprise" in the custody centre when Pichiu deemed Lewis-Ranwell fit to be released with no further assessment.

Asked about that, Pichiu, who was working a 07:00 to 19:00 shift and based in Plymouth, said: "I would say that's not correct... I honestly don't remember not being happy to be there."

The inquest previously heard Lewis-Ranwell was released from Barnstaple police station on the morning of 10 February and killed Payne and the Carters later the same day.

Lewis-Ranwell was charged with their murders but found not guilty of murder by reason of insanity and was given a direct hospital order after a trial later in 2019.

The inquest continues.

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