The Becklin Centre is near St James's Hospital in Leeds
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The body of a hospital patient at risk from self-harm lay undiscovered on a ward for four days, an inquest heard.
Kevin Hackney, 46, had been admitted to the Becklin Centre psychiatric unit in Leeds after a suicide attempt.
When Mr Hackney, of Rodley, Leeds, went missing, it was assumed he had left the hospital, the ongoing hearing was told.
But four days later it was found he had apparently cut his throat with a razor in a shower room and had been there since the day he disappeared.
Died quickly
He was only found on the morning of 2 June 2003 when a patient complained of "bad smells" coming from the shower, the inquest heard.
A post-mortem examination found that he would have died very quickly.
Coroner David Hinchcliff said the shower room appeared to be the "ideal location" for anyone contemplating self-harm because there was little chance of being disturbed.
On the morning he went missing, Leeroy Sanford, a health support worker, had been checking Mr Hackney at 15-minute intervals.
Search launched
He told the inquest he had not seen the patient during one round of checks and assumed he had gone to the shop. But when he failed to appear, Mr Sanford launched a search for Mr Hackney.
He said he did go into the shower room and knocked on the door of the locked shower, where Mr Hackney had killed himself. But hearing no reply, he moved on.
Gone missing
He explained his suspicions were not aroused by the locked door because the shower was often flooded and out of order.
After failing to find him, West Yorkshire Police and Mr Hackney's mother were informed that he had gone missing and it was assumed that he had left the hospital.
Mr Hinchcliff asked Mr Sanford if it was a mistake in hindsight that he had not checked the locked shower. "Yes," he replied.