The care given to a man who died in a flat fire in the weeks before his death has been put in question at his inquest, which opened yesterday.
David Keith Morgan died at the age of 66 in a fire at his flat at Lord Coutanche Court, Seaton Place, in the early hours of Monday 4 August 2025. His medical cause of death was carbon monoxide poisoning with a secondary cause of death of starvation, the inquest heard.
In a statement read out during the inquest, his former partner Fiona Healy described him as a “quiet and private man” who had developed anxiety after breaking his ankle during the pandemic, which led him to be at home more. She said he struggled to put weight on and she would visit him at his flat to encourage him to eat.
About six weeks before his death, she said, he started cleaning at “strange times in the middle of the night” which was “very unlike him”.
The inquest heard about symptoms like him writing on the walls of his flat, an incident when he was found lying down in the communal garden outside his flat, and how on a cruise he appeared to be on drugs and did not leave his cabin for several days.
Earlier that summer, Mr Morgan made threats to set himself on fire and to kill family members, the inquest heard.
Ms Healy said she “believed David to be very unwell” and that he needed sectioning “for his own safety”.
“I was genuinely concerned that something was going to happen to him,” she said.
“I feel as a family we were crying out for help for David but nobody listened.”
She added: “I genuinely believe that he was suffering from some form of psychosis.”
She described his behaviour as “increasingly erratic and bizarre”, and that there was “a significant deterioration in his mental health during which he became increasingly reliant on medical cannabis”.
“We could see that David wasn’t right and we reached out to all the right agencies who should have been able to help him.”
“I genuinely believe if David had been seen and detained, he would still be alive now.”
She asked why, despite his symptoms, he continued to be prescribed cannabis.
The inquest heard from police officers and Fire and Rescue about a number of call-outs they received to Mr Morgan’s home. In July 2025, there were three Adult Protection Notifications made, including about an incident when he is said to have threatened to set himself on fire.
These are used by police officers in cases where people need additional support. They make a referral to the Public Protection Unit, which forwards concerns to a “single point of referral”, which is separate to the States police.
Advocate Matthew Berry is sitting as coroner. The inquest is due to last three days from Monday to Wednesday.
