'Difficult to understand' why killer allowed out

Roger Leadbeater's family have described him as "a true gentleman"

The family of a man killed by a woman who had absconded from a secure hospital told an inquest his death was "preventable".

Emma Borowy, 32, killed 74-year-old Roger Leadbeater as he walked his dog, Max, in a park in Sheffield on 9 August 2023.

Giving evidence at his inquest on Thursday, Mr Leadbeater's family said there were "so many missed opportunities".

Mr Leadbeater's niece, Angela Hector, said: "My only hope would be that no other family goes through what we have been put through."

The inquest was told Ms Borowy, who had been diagnosed with schizophrenia and psychosis, had escaped from the Royal Bolton Hospital eight times after she was sectioned under the Mental Health Act in October 2022.

The mother of one, from Bolton, had also tried to escape on at least eight other occasions and talked of "hurting people" just days before she killed Mr Leadbeater.

Senior coroner Tanyka Rawden said Mr Leadbeater, a retired bus driver who was working as a minibus driver for children with special needs at the time of his death, suffered a total of 75 "sharp-force injuries", including a wound to his right eye.

Ms Hector, who is representing the family at the inquest, said her uncle "died in the most horrendous and undignified circumstances".

She described him as "kind, loyal, caring" and "a true gentleman".

"He was more than just an uncle. He took on the role of dad, brother, grandad and friend.

"He played a massive part in our family and now there is a huge black hole which we will never be able to fill."

Ms Hector said her uncle, who was killed in a seemingly random attack, had "walked his dogs on that field around that time for 27 years".

"For him, he was in the right place at the right time."

His dog remained by his side but had to be put down because of the "trauma" he witnessed, she added.

A prison officer at HMP New Hall, where Ms Borowy was being held on remand after being charged with murder prior to taking her own life, said she "often spoke about how awful she was and couldn't believe what she had done".

"Emma stated she didn't think anyone could help her, wished it hadn't happened, and said it was unforgivable."

Emma Borowy took her own life while on remand

'Very concerned'

Thursday's hearing at the Medico-Legal Centre was also told a serious incident review following Mr Leadbeater's death found the doctor in charge of Ms Borowy's care went against policy by allowing her leave from the hospital on 7 August before she absconded.

Ms Rawden said she was "very concerned" by the decision from Dr Dilraj Sohi, a consultant psychiatrist, to grant Ms Borowy further leave after a 30-minute meeting in which a total of 40 patients were discussed.

Dr Sohi had also never met Ms Borowy, who had gone AWOL three days previously.

Emma McDaid, the author of the report, said the doctor "should have seen her" in person before making a decision on whether to let her out.

A decision to grant Ms Borowy further leave should have been made by a "multi-disciplinary team", she added.

"There is always some clinical variance, that needs to be considered. However, I would expect [guidelines] to be followed and if there was a variance from policy I certainly would expect a clinical rationale for that reason."

Dr Sohi previously told the inquest a vulnerable adult form created by South Yorkshire Police on 4 August after officers had located Ms Borowy while she was AWOL had not been shared with the hospital.

The form described her as "delusional, suicidal and talking about hurting people".

Dr Sohi said the "likelihood" was that he would have still granted leave to Ms Borowy on 7 August, even if he knew that information.

"We do live in hope that people can and will improve," he said.

Ms Rawden said she may need to enlist the help of an independent expert in psychiatry to help her decide whether the actions of the Greater Manchester Mental Health NHS Foundation Trust in particular were "reasonable based on the evidence of what was known at the time".

She added that the decision-making process of the Trust in granting leave was "difficult to understand".

"It's so important that lessons are learned from this," she said.

Ms Rawden adjourned the inquest and set a review date for 7 March.

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