Lack of information sharing 'could lead to more deaths' after 95-year-old attacked

May Miller, 95, was assaulted in her room at Beech House care home by another resident with a metal

May Miller, 95, was assaulted in her room at Beech House care home by another resident with a metal walking stick. Photo: Bonita Dickman - Credit: Archant

Failure to share information between care providers could lead to more care home deaths, a coroner has warned after a 95-year-old was fatally attacked.

May Millermoved into Beech House Residential Care Home, in Halesworth, five days before being attacked by fellow resident David March, 89.

While Mrs Miller died of natural causes after being admitted to hospital in the wake of the attack, an inquest into her death at Suffolk Coroner's Court in October found the assault could have increased the speed of her deterioration.

Now, Suffolk area coroner Jacqueline Devonish has completed a Prevention of Future Deaths report after concerns over a lack of information sharing between agencies. 

Mr March, who was described as "belligerent and aggressive" in an initial assessment by a warden from The Limes Sheltered Housing where he had previously lived, had been rejected from another care home following concerns about his declining condition, before moving to Beech House.

The report states: "This was a very sad death indeed.


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"May Miller, although frail by virtue of her age, was well and happy when she became a resident on February 4.

"While in her room asleep on February 9, she was attacked by another resident who beat her around her head and face with his walking stick."

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Staff at the care home attended immediately after hearing screams and found Mr March standing in the corridor, unable to recall what had happened.

The report states: "There was no formal procedure for vetting or assessment except the request for a GP report.

"His behaviour [at the Limes] had deteriorated and appeared to be aggressive and sexually motivated."

The Limes is not a registered care facility, but instead a block of flats with a warden keeping an eye on residents, the inquest had been told.

Ms Devonish heard Beech House was unaware of Mr March's deteriorating behaviour and were unable to request information from professional sources as he was arriving from an unregistered facility.

The report states because of GDPR, the GP was "unable to disclose full information to the Limes or to Beech House about any previous conduct or assessments.

"It was established during the evidence that multiple investigative agencies may have been aware of Mr March's risk factors, but due to his not having been admitted to Beech House from a registered facility, that information sharing was not possible.

"Had there been in place a system for sharing information with the Limes and Beech House, there may have been an opportunity to safeguard May Miller."

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