AN INQUEST in Milford Haven has concluded that a 67-year-old disabled man who fractured his neck after a fall in a care home in Carmarthenshire did not receive appropriate care – but it did not conclude how the injury was suffered.
Heddwyn Hughes, died in October 2015, five months after the fall at Bro Myrddin care home in Carmarthen.
Recording a narrative verdict on Friday (Oct 19), the jury said it believed Hughes suffered the injury in his bedroom after returning from the bathroom.
The inquest jury found that staff at the Hywel Dda Health Trust did not respond with sufficient urgency, or appropriately and that protocol was not adequate and is in need of review. There were failings, the jury found, in the way that staff and GP communicated.
During the three-day inquest the jury heard that Hughes began having seizures when he was about 10 months old. He had poor communication skills and spoke few words but communicated with staff by smiling or slapping the table or his legs. He could feed himself and “shuffle” around the home.
The inquest heard on the morning of 6 May, 2015, Mr Hughes suffered a “catastrophic” injury after he collapsed to the floor of his bedroom when he was being lifted by a staff member, but it took around four hours for him to be seen by a medical professional, and it later was revealed he had broken his neck.
It was said that Mr Hughes was likely to have become quadriplegic at the point of injury. He died in Glangwili Hospital five months later, with a Hywel Dda pathologist stating that he had died from natural causes.
Speaking to the Herald outside Milford Haven Town Hall, Mr Hughes’ sister Moelwen Gwyndaf said: “At the centre of all this is my brother, Heddwyn, who was much loved and whose life required so much support. His legacy will be that other such vulnerable adults in the care of the state and who cannot say what has happened to them will have protocols and procedures in place that will ensure their safety and care. I would like to thank the coroner and jury for their thorough investigation.”
Dr Warren Lloyd, associate medical director and clinical director for mental health and learning disabilities services at Hywel Dda University Health Board said: “We wish to offer our sincere condolences to Mr Hughes’s family for their loss.
“The health board accepts the inquest findings and we wish to reassure Mr Hughes’s family that we have taken this matter extremely seriously. We have undertaken significant work over the past three years to improve our compliance with expected standards and a protocol issued to staff will be further developed in consultation with Mr Hughes’s family following the conclusion of the inquest verdict and recommendations.
“The health board continues to invest in improving awareness of the needs of patients with a learning disability and have recently recruited dedicated nursing support to provide advice and assistance in understanding the needs of people with a learning disability, who may be under the care of our general hospital wards and community settings.”
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