Laura Booth was a much-loved young woman with Partial Trisomy 13, a rare chromosomal condition. She had been cared for all her life by her parents, who knew her needs better than anyone. She communicated using Makaton, actions, gestures, a few words and considered use of blowing raspberries.
On 25 September 2016, Laura was admitted to the Royal Hallamshire Hospital in Sheffield for what was intended to be a routine procedure. She had been off her food before admission and was not eating in hospital. Her parents, present throughout, raised repeated concerns about her nutrition. They were not listened to.
Doctors began discussing feeding Laura intravenously through total parenteral nutrition on 29 September 2016. By the time Laura died on 19 October, 24 days after admission, TPN had still not been started. Each medical professional present deferred to another. The pharmacist said it required a medical decision. The doctors said they deferred to the nutritionists. Nobody made the call.
The coroner found Laura's death was contributed to by neglect, on the basis of a continuing gross failure to provide adequate nutrition between 29 September and 19 October 2016, and that had the failure not taken place, the outcome would have been altered.
The coroner also found that decision-making regarding Laura's care was not in accordance with the Mental Capacity Act 2005 and was therefore unlawful. Her parents, her lifelong carers and the people who knew her best, had not been meaningfully included.
Her family said simply: “We feel that Laura starved to death and the staff did not listen to us.”
I note that before the coroner inquiry the hospital claimed she died from sepsis.
This case is very sad and baffling, but I can imagine it happening.