Care home fined Â£75,000 after patient choked to death on piece of orange
A south Down care home has been fined Â£75,000 for a health and safety breach which led to a resident choking to death on a piece of orange.
Mervyn Patterson, who had severe autism and learning difficulties, was a resident at Seeconnell Village Residential Home in Castlewellan in March 2014 when he passed away.
Fining Corriewood Private Clinic Ltd – the registered organisation in control of Seeconnell – for the breach which led to Mr Patterson’s death, Judge Piers Grant said: “I want to make it absolutely clear that no-one should view the imposition of a fine as an indication that this court takes the view this is the cost of a life, or the value of Mr Patterson’s life. On the contrary.”
Branding the death of the 57-year old as a tragedy, Judge Grant spoke of a life cut short. He also said “no sentence I impose can bring him back to life or assuage the grief of the family”.
Downpatrick Crown Court, sitting in Belfast, heard that prior to being moved to Seeconnell in December 2013, Mr Patterson had spent over 40 years in Muckamore Abbey Hospital.
He and four others were ‘resettled’ under the Community Integration Project, and when Mr Patterson was first moved to Seeconnell, for the first three days staff from Muckamore were present to advise his new carers on his specialist level of care.
An assessment was carried out the following month, and issues were raised about Mr Patterson’s food intake. The court heard his swallow function was limited, any food given to him should have a soft, mashed texture and he should be upright and alert when eating.
It was also noted that Mr Patterson should be fed with a teaspoon, as he tended to overload his mouth, and that any fruit should be peeled.
In addition, the assessment concluded that Mr Patterson should be directly supervised at meal times, and that he should be prompted to slow down.
On the evening of March 20, 2014, Mr Patterson started to choke. First aid and CPR was administered by staff whilst the emergency services were called. Despite best efforts, Mr Patterson died from choking, and when a post-mortem was conducted, a segment of orange including the peel was located at the back of his throat.
An investigation was launched, and it emerged that on the night in question, a 19-year-old support worker prepared a supper of oranges, other fruit and yoghurt. It also emerged she had never read Mr Patterson’s care plan, nor been given time to do so, and was not aware of his specific dietary requirements.
Another worker said he fed Mr Patterson his medication with the yoghurt and took the medicine cups to the office – which left the resident unsupervised for around a minute. The worker said he saw Mr Patterson coughing and was able to remove some orange peel from his mouth.
He said he was aware of Mr Patterson’s issues with food, and believed oranges were a suitable foodstuff.
A multi-agency investigation was launched, and Corriewood Limited subsequently pleaded guilty to a single count of failing to ensure the health and safety of a non-employee, under the Health and Safety at Work (Northern Ireland) Order 1978.
In his sentencing remarks, Judge Grant noted that Corriewood Ltd came before the court with no previous convictions and “excellent testimonials about the way this premises has been managed over a number of years’’.
The judge also said that whilst the company was responsible, it was “quite clear significant failures occurred” which led to Mr Patterson’s untimely death.
He fined Corriewood £75,000 and gave the company four months to pay.
In a statement issued after the resolution of the case, Corriewood Private Clinic Limited said: “We accept the judgment today and apologise wholeheartedly to Mr Patterson’s family for this tragic accident.
“We continue to work in partnership with relevant health and social care trusts to ensure our ongoing care to residents is exemplary.”