Concern over 'do not resuscitate' decision for Lincolnshire woman with Down's Syndrome
A WOMAN who had Down’s Syndrome and severe learning difficulties died after swallowing a piece of her incontinence pad, blocking her airway.
Spilsby and Louth Deputy Coroner Dick Marshall gave an accidental verdict into the death of 44-year-old Louise Beverley Applebaum who was found unresponsive in her bedroom at Melody Lodge Care Home in West Keal.
The inquest heard that although paramedics found and felt a pulse, a Do Not Resuscitate decision was made by a doctor following her arrived at Pilgrim Hospital in Boston.
That decision caused concern from the care home, Miss Applebaum’s care provider and a paramedic.
Miss Applebaum had been at the care home most of her life and was under the general care of Redbridge Council in London. She had no family.
She had considerable care needs: she could not speak, suffered double incontinence and had limited walking ability. She had also suffered a stroke in 2009. The inquest heard that Miss Applebaum had the mental age of an 18-24 month old.
She had a habit of trying to eat anything she could get hold of, had previously swallowed £1 coins and was in the habit of picking and eating her incontinence pads.
On May 10 last year, she was put into bed as usual by care workers.
At 9.11pm she was checked by staff and was seen again at 9.56pm where she was found lifeless.
On arrival, the ambulance crew continued CPR and removed material found in her airway which had come from her incontinence pad.
She regained a pulse which was monitored on machinery but when they took her to Pilgrim Hospital, doctors later made a decision not to resuscitate.
The inquest heard that paramedic, Sherry Hanson, raised her concerns to her line manager the following day through the incident reporting process, but had not heard the outcome.
The A&E records show that Miss Applebaum lost output again at 11.15pm.
Deputy Coroner Dick Marshall said: “That decision I know has caused people some concern. We do have some additional material about the decision taken and it appears to be within the reasonability of clinical decision. She had numerous other medical problems and her assessment was CPR was likely to be unsuccessful and she was not a likely candidate for successful treatment in ITU [intensive therapy unit]. This is a decision I am not able to criticise.
“I have considered very carefully any evidence of a lack of care and in my judgement there is no such evidence. This is one of those tragic situations and it is only with the benefit of hindsight that possibly more could be done.”
The inquest heard that the PCT had recently issued a new type of incontinence pad for Miss Applebaum, following a change in the company which supplied them.
The care home manager, Dawn Mellor said she felt the previous kind of pad had been better at preventing her from picking the lining.
A post mortem report showed there was cotton in Miss Applebaum’s oesophagus and material in her stomach.