A mental patient who once killed a man was allegedly handed a freedom pass by Springfield Hospital staff hours before he fled and was hit by a train.

An inquest on Tuesday heard how Paul Caesar, 36, walked in front of a train at Balham station two hours after absconding from hospital grounds in February 2009.

On the morning of his death, staff handed over the card, which allows access to public transport, despite the fact he was forbidden to leave the grounds, Westminster Coroner’s Court was told.

Dr Shirley Radcliffe, coroner, asked consultant psychiatrist Dr Gillian Mezey whether she thought his request for the pass should have rung “alarm bells”.

She answered: “Maybe with the benefit of hindsight, yes. I think with Paul, because he had always been so completely trustworthy – he had not broken any rules and he had always complied and no concerns had been raised – it might be that alarm bells didn’t ring as they would with other patients.”

The court heard how Mr Caesar, who was diagnosed with schizoaffective disorder, spent time in Belmarsh Prison and the high-secure Broadmoor Hospital after killing a man in 1996.

In October 2002 he was sent to the medium-secure unit at Springfield Hospital in Tooting for rehabilitation back into the community, and was discharged and readmitted several times.

During his time there, staff described him as a “model patient” who earned the right to walk around the grounds unescorted because of his good behaviour.

But Dr Mezey said the patient was disappointed at the rejection of his application to be allowed outside the grounds alone, and as time went on he became increasingly tortured by his crime.

She said: “He never seemed to forgive himself for having killed someone.”

At 11am on February 17, 2009, Mr Caesar left the Halswell ward for his ground leave and never returned.

Two hours later, at about 1pm, witnesses saw him walk on to the tracks at Balham station before being hit by a train travelling at 65mph. In a suicide note found after his death, he had written how he hated living on the ward.

Dr Mezey told the inquest Mr Caesar was scheduled to go to the cinema with an escort the following day, which could explain why staff gave him the freedom pass. The inquest continues.