Care boss claims 'completely false' or 'grossly exaggerated'
CORONER John Lock has been asked to regard some statements made by BE Lifestyle managing director Belinda Wardlaw as either "completely false” or "grossly exaggerated”.
Counsel Assisting the Coroner Megan Jarvis made the recommendation on the final day of evidence in the probe into the 2013 death of quadriplegic mother-of-two Leah Floyd.
Ms Jarvis made the submission in regard to Ms Wardlaw's claims that Mrs Floyd was displaying suicidal behaviour in the lead up to her admission to the Nambour General Hospital's psychiatric ward.
Mrs Floyd spent a fortnight in hospital before being discharged back to BE Lifestyle's Yandina Creek care home on September 19, 2013.
The court heard it was difficult to determine why Ms Wardlaw would exaggerate statements of Mrs Floyd's suicidal ideation.
It was suggested that Ms Wardlaw wanted Mrs Floyd out of her care home to make way for another client, but Ms Jarvis said that was not substantiated.
Ms Jarvis said the Coroner should instead accept evidence given by other professionals involved in Mrs Floyd's care that she was positive about her future and had an obvious love and concern for her children.
It was noted that Mrs Floyd's family and BE Lifestyle had raised concerns about the appropriateness of their care home to cope with Mrs Floyd's medical and mental health needs.
"However, it must be acknowledged that Belinda's actions regarding Leah's admission to Nambour Hospital for a mental health assessment, and the way in which this was carried out, did appear to have had a significant impact on Leah's mood and decision making,” Ms Jarvis said.
She said that included Mrs Floyd's decisions not to go to hospital or attend appointments with Coast GP Dr Karen Sander, who had prepared the written referral for Mrs Floyd's admission to Nambour General Hospital for a mental health assessment based on information from Ms Wardlaw.
Ms Jarvis said the "over inflation” of mental health concerns did not directly contribute to Mrs Floyd's demise but she believed they played a significant part in her reluctance to return to hospital after her discharge from the psychiatric ward September 19, 2013.
Mrs Floyd did ultimately return to Nambour General Hospital on October 6 after initially refusing requests from BE Lifestyle to go for medical treatment.
She died of septicaemia four days later.
Ms Jarvis listed a number of factors she believed contributed to Mrs Floyd becoming gravely ill.
They included whether or not she was being effectively repositioned to relieve pressure on a pressure wound she had on her lower back and uncertainty as to how long her air mattress had been deflated before the problem was detected by a visiting Blue Care nurse on September 27.
The court heard it could have been deflated for one or two hours or for up to three days.
Mrs Floyd's pre-existing vulnerabilities such as the fact she was a smoker, had respiratory problems and was thin were also listed as contributing factors.
Her refusal to go to hospital was also noted.
"It appears her decisions in this regard were being made due in part to a fear of losing her place at BE (Lifestyle) and also, at least on 5 October and possibly earlier, a desire to wait until a planned visit from her children, which was to occur on the morning of 6 October,” Ms Jarvis said.
"These decisions unfortunately did appear to play a significant part in Leah's demise, although it can not be known whether earlier medical review would have made a difference to the outcome.”
Ms Jarvis noted BE Lifestyle's home was not a traditional care "facility” or "institution” and as such did not have the type of clinical governance framework expected in the more traditional settings.
She said that framework might have included risk management strategies and clinical care standards related to pressure sore prevention and management, which would have required things such as minimum qualifications and training for staff as well as minimum documentation standards regarding wound management.
"I suggest that this could potentially be an area in which a meaningful recommendation might be made, namely, that organisations providing nursing services to people with a disability in the community ensure they have appropriate policies and practices for ensuring adequate communication in all care settings, including private homes with paid, professional but medically untrained carers.”
Barrister Amanda Coulthard, who appeared for BE Lifestyle, said the business had since made improvements to the way information from external medical practitioners, such as Blue Care nurses, was communicated to carers.
She acknowledged Ms Wardlaw's conduct in having Mrs Floyd admitted to the psychiatric ward could be criticised but said the decision was based on a "pastiche” of information Ms Wardlaw was relying upon and a genuine concern for Mrs Floyd.
Ms Coulthard said Mrs Floyd's lack of trust for Ms Wardlaw did not contribute to her decision not to go to hospital for medical ailments in early October 2013.
She accepted the fact that Mrs Floyd's air mattress was found deflated was a significant issues but said it was difficult to conclude it had been down for any more than one or two hours.
She said Ms Wardlaw thought her carers had done a good job in looking after Mrs Floyd.
Mr Lock said he hoped to complete his decision in the coming month.