AN ELDERLY man who died after falling several times while in hospital care was not “adequately supervised”, an inquest heard yesterday (Wed).
Dennis O’Brien, of Cwm, died in May 2012 after suffering a number of accidental falls while admitted at both Nevill Hall Hospital in Abergavenny and Ysbyty Aneurin Bevan in Ebbw Vale.
Gwent Coroner’s Court, sitting in Newport yesterday (Wed), heard how the 80-year-old had been admitted to Nevill Hall on April 23, 2012, following an accidental overdose of prescribed medication.
The former coal miner had suffered from hallucinations and impaired hearing and vision for a number of years.
Giving evidence, Mr O’Brien’s daughter, Sharon Davies, said how her father had suffered a fall within a day or so of being admitted to hospital. She said he had suffered a haematoma to his left eye and was slurring his words, but could not recollect how exactly he had fallen, but was “very agitated”.
Mr O’Brien had an inconclusive CT scan before he was transferred to a smaller facility in Ebbw Vale on April 26.
Mrs Davies told the inquest she did not feel her father was “in a fit state” to move to unfamiliar surroundings to “recuperate” as one of the nurses had suggested.
She questioned whether keeping her father alone in a room would aid his healing, having just suffered a fall.
Mr O’Brien suffered a further fall on April 27, when Mrs Davies was called in again. She said: “There was blood everywhere. He was shouting the names of his national services friends – he had gone back 50 years. It was absolutely manic there and there was no doctor on the ward.”
An ambulance was called to transfer Mr O’Brien back to Nevill Hall, where he suffered yet another fall and sustained severe injuries. A CT scan later showed he had bleeding on the brain, and it was decided by doctors that palliative care would be given to him rather than intervention by neurosurgeons. Mr O’Brien died on May 23, 2012.
Margaret Evason, a registered nurse at Ysbyty Aneurin Bevan, told the inquest there were six nurses on duty the night Mr O’Brien fell at the care unit before being transferred back to Abergavenny, rather than the usual seven. She also said nurses failed in their efforts to contact the on-call doctor and was forced to call an emergency ambulance instead.
The conclusion of a post-mortem examination report, carried out by consultant pathologist Dr Geraint Evans, said Mr O’Brien died of bronchopneumonia as a result of a head injury, adding other factors, such as his heart disease, could have contributed to his death.
Gwent coroner David Bowen recorded a death, in a semi-narrative form, due to an “accidental fall of a patient who was known to be agitated and who was not adequately supervised”.