The teenager, who should have been under constant supervision on the children's psychiatric ward, was left alone by her support worker at Taplow Manor Hospital in Berkshire. Fifteen minutes later, she had fatally self-harmed.
The worker assigned to her had only one-and-a-half days' training and had faked his identity using false documents.
Earlier this month, a jury at the inquest into Ruth's death concluded she was unlawfully killed. Despite this, there have been no criminal prosecutions.
Speaking to Sky News and The Independent in their first TV interview, Ruth's father, Mark, said: "She went somewhere that was supposed to be helping her, and it made her worse. The isolation and lack of access to her family had a massively negative impact."
Her mother, Kate, added: "The children get lost. Ruth got lost. She was lost in the middle of all this chaos."
Ruth's parents have said the hospital's strict visiting regime meant they were unable to see their daughter as often as they had wanted. Her father never saw her room.
"Her access to us was denied," Mark said. "We were willing and able to give that support. It completely derailed her."
The family believe that if Ruth had been allowed regular contact with them, she would still be alive.
History of failings
The failures at Taplow Manor were well-documented. Investigations by Sky News and The Independent uncovered disturbing evidence about the treatment of young people.
There were numerous critical reports, including three from the Care Quality Commission (CQC) regulator in the year leading up to Ruth’s death, each one highlighting unsafe practices.
Despite this, the NHS continued to send vulnerable children there.
At Ruth's inquest, an NHS clinician in charge of commissioning her care admitted they knew about the issues at the hospital.
The inquest heard there were no other psychiatric intensive care units close enough to send her to.
Steph Smith was a former patient at Taplow Manor - then known as The Huntercombe Hospital Maidenhead - in 2017, who later went on to work at the unit as a healthcare assistant between September 2021 and February 2022.
She described the ward as "chaotic, scary and intense".
"There was a huge culture of covering things up," she said.
"Observations weren't done. People just signed the paperwork at the end of the shift. On paper, it looked fine, but in reality, children were left at risk.
"It was only a matter of time. It breaks my heart that it took a 14-year-old girl dying for the hospital to close. It should have been shut years ago."
Staff warned managers
Nurse Ellesha Branaghan worked as a clinical team leader on Ruth's ward. She and colleagues warned managers about shortages on the rota.
"We would often tell them the staffing levels weren’t safe but we just kept getting told these are the numbers," she said.
She said a lack of staffing often meant patients could not go on leave, or even visit the hospital gardens.
There were occasions, she said, when patient observation levels were decreased because there were not enough staff on shift.
"Sometimes we would have four or five incidents at the same time," she added. "We didn't have the staff to respond, so that becomes unsafe."
The staffing levels became "so severe" that even patients wrote to senior managers to express concerns.
An NHS England spokesperson said: "All providers must operate to the highest standards and the NHS worked with young people and families to move patients from Taplow Manor to other clinically appropriate services."
The 'loophole'
Taplow Manor was finally closed in 2023. The CQC had visited the hospital just 11 days before Ruth's death.
High-level feedback was given following this, highlighting concerns with the environment, care plans not being followed and staffing levels.
After further inspections in March 2022, the watchdog issued a warning notice about failings in patient observations.
But once a warning notice is issued, that particular issue cannot be the subject of a criminal prosecution - something Ruth's parents describe as a "loophole".
Mark said the CQC opened an investigation into his daughter's death and looked at a "number of different routes to potentially prosecute the Active Care Group".
Active Care Group acquired the Huntercombe Group, which ran Taplow Manor, in December 2021.
Mark said the regulator was not "allowed or able to prosecute, even though the same failing happened with catastrophic consequences".
'No justice for Ruth'
The CQC said it did carry out a full criminal investigation but the evidence "did not meet the threshold".
It added that there was no suggestion the outcome would have been different if there had been no warning notice.
For Ruth's parents, this is unacceptable.
"Why did our daughter have to die before anyone paid attention?" Kate asked. "They knew all this before she died."
The inquest ruling of unlawful killing has brought no comfort to Ruth's family.
"There can be no justice for Ruth," her father said. "She's dead, she's gone. We're left with the fallout."
A CQC spokesperson said the regulator began a criminal investigation in November 2022 but "found that there was not sufficient evidence to charge".
"We know that this was disappointing for Ruth’s family, and we met with them to explain how we came to this decision," the spokesperson added.
"We have a range of enforcement powers available to us and criminal action is only an option when the evidence demonstrates without any doubt that there have been organisational failings that can be proven to the required legal threshold."
Following Ruth’s death, the CQC continued to visit the unit. A report published just six months later raised more concerns over observations, saying "there had been 22 incidents involving poor practice with observing young people".
It went on: "The incidents ranged from staff falling asleep, not following young people when they left the room and completing other tasks whilst they were meant to be observing someone."
It was rated inadequate in December 2022, before its closure.
Ex-patients voice concerns
Ruth's case echoes concerns raised by other former patients.
Amber Rehman, who was admitted to Huntercombe Hospital in 2019, said: "Ruth’s story - I’ve heard so many similar stories. It could happen to anyone. It could still be happening out there."
Amber's mother, Nikki, said: "It was absolutely preventable. No one made changes."
Amber's family made a formal complaint about the care she received.
An independent review was commissioned by the hospital, which found issues with observations - including missing observation records - and an over-reliance on physical intervention and medication.
The review - which was published exactly a year before Ruth harmed herself - recommended an audit of the observation records, and said the way the hospital communicated and engaged with families should be looked at.
Sky News has seen two other independent reports commissioned by the hospital before Ruth died, raising similar concerns - including engagement and communication with the patient's family.
Fifty former patients came forward to our investigation in 2022 to share their experience of this hospital and a number of other units run by the same provider.
Many have told us how they still struggle with trauma from what they faced while under its care - some have formal diagnosis of PTSD due to it.
Sky News understands that 58 former patients are now taking legal action against around 30 psychiatrists who worked at various Huntercombe hospitals over two decades.
Sky News investigations into Huntercombe Group units:'Blood on the walls': Shocking truth of life on mental health unitThirty ex-patients reached out to Sky News after initial probe'Inadequate staffing' at hospital 'put young people at risk'
A statement from Active Care Group said: "We extend our heartfelt condolences to Ruth’s family, friends, and all those affected by her passing. We deeply regret the tragic event that occurred, and we are truly sorry for the distress this has caused
"We directed significant investment in staff training, recruitment, and the hospital estate, spending more than £3m on the physical environment alone over an 18-month period.
"Despite these efforts, by early 2023, it became clear that achieving the high standards of care that reflect our core values would not be possible within an acceptable timescale.
"In recent years, we have made significant improvements to the quality and safety in all of our services.
“We are regrettably unable to comment on historical allegations relating to care provided under previous ownership or management.”
Elli Investments Group, owners of The Huntercombe Group until 2021, previously told us: "We regret that these hospitals and specialist care services, which were owned and independently managed by The Huntercombe Group, failed to meet the expected standards for high-quality care."
'Our lives are darker without her'
Ruth's parents, who are both doctors working in the NHS, are calling on the government to close what they see as the "legal loophole" in the powers the CQC has to prosecute.
They also want to strengthen safeguards for children in mental health units by ensuring parents have visitation rights to their children.
"Ruth died under the care of the state," her mother, Kate, said.
"We very much hope that secretaries of state for health and for mental health are listening to Ruth’s story, and that they can use this opportunity, particularly to make sure that children have unrestricted access to their families."
A Department of Health and Social Care spokesperson said: "Our deepest sympathies are with Ruth's family and friends. This is a shocking case and it is clear care at Huntercombe Hospital fell far below the standards we expect.
"Where appropriate the CQC can bring prosecutions where a provider has failed to comply with a warning notice, and we are clear that those that harm patients through negligence or mismanagement should face the consequences.
"We are investing £75m this year to reduce inappropriate out of area placements, increasing family involvement in patient care through the Mental Health Bill, and driving up standards through the 10 Year Plan so everyone receives the level of care they deserve."
Ruth's parents are both struggling with the lack of accountability over their daughter's death, especially the decision by the CQC not to prosecute.
"We don't have faith the system will make sure changes happen," Mark said.
"Governance has been completely ineffectual. Until there is real accountability, nothing will stop this happening again."
Kate added: "Our lives are darker without her. Ruth was unique and wonderful. She kept us wholehearted in everything we did. Now she's gone."
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.
