Death of woman who fell from top floor of Pinderfields Hospital 'may have been preventable' report says, as family call for lessons to be learned
The family of a woman who fell to her death from the top floor of Pinderfields Hospital are calling for lessons to be learned following a report which said her death "may have been preventable" if clearer guidelines were in place.
Michaela Fowler from Overton, was admitted to hospital on June 12, 2018 after complaining of breathing difficulties.
Her husband Stephen said she suffered from COPD and osteoporosis, and had begun displaying strange behaviour in the days before her admission, including signs of delirium.
After being taken to hospital by ambulance, Michaela, 60, was admitted to a ward with delirium thought to be caused by her COPD.
Later that day, a nurse was required to change bedding and left the ward for "a few minutes", according to a report from Niche Health and Social Care Consulting.
During this time, Michaela exited the ward. Shortly after, she was found to have fallen from the top floor of the hospital's main stairwell.
Resuscitation was attempted, but she was pronounced dead in the early hours of June 14 as a result of the injuries sustained in the fall.
Husband Stephen, now 65, and sons Michael and Daniel, now 29 and 32, are now calling for lessons to be learned following Michaela's death.
Stephen, who was married to Michaela for 32 years, said: “Losing Michaela so suddenly and tragically left the family devastated and I still think about her every day.
“Michaela and I were going to live out the rest of our years together and that’s been taken from us in the worst way.
"To know how much Daniel and Michael miss their mum is heartbreaking. I really wish I could turn back the clock and stop it from happening, but I know that isn’t possible.
“All I can hope for now is that something is learnt from this to stop other families from facing such pain and suffering as I wouldn’t wish this on anyone.”
According to the report from Niche, Michaela's death "may have been preventable" if national guidance on the management of delirium was "clearer and more decisive in how interventions should be managed” and if staff were “familiar and trained in the use of this guidance.”
The report recommended a review and re-launch of the delirium guidelines at the Trust along with training on the identification, treatment and management of delirium.
A spokesperson for the Mid Yorkshire Hospitals NHS Trust, which runs Pinderfields Hospital, said all of the recommendations in the report had been implemented.
Daniel, Michaela's eldest son, said: “Whilst the care my mum received during her time at Pinderfields was woefully inadequate, we are grateful for the way the Trust has handled this ever since – acting sensitively, professionally and responsively throughout.
"A particular thank you goes to the team at Irwin Mitchell for fighting for my mum every step of the way. She would be proud.”
The family's legal team, from Irwin Mitchell LLP, have now secured an undisclosed settlement fro the Trust in connection with Michaela's death.
A spokesperson for Irwin Mitchell said it followed an admission by the Trust that once it had been decided that Michaela needed one to one care, “she should not have been left alone at any stage”, adding that “leaving her alone constitutes a breach of duty.”
It further admitted that had she not been left alone, “on the balance of probabilities she would not have left the ward” and her fall “would have been avoided", the legal team said.
Sanna Mazhar, specialist medical negligence lawyer at Irwin Mitchell representing Michaela’s loved ones, said: “It’s almost three years since Stephen and the rest of the family lost Michaela, and they’re understandably still devastated by their loss.
“While nothing will ever make up for what happened or bring Michaela back, we’re pleased to have helped provide Stephen and his sons with the answers they deserve so they can start to try and move forward with their lives as best they can.
“We also urge that lessons are learned from Michaela’s tragic death to improve patient safety and ensure that other families don’t have to suffer like this.”
David Melia, Director of Nursing and Quality at The Mid Yorkshire Hospitals NHS Trust, said: “We once again offer our heartfelt condolences and sympathy to Michaela’s family and we understand that this has been a very traumatic time for all involved.
“We want to reassure the family that we have implemented all of the recommendations of the Niche Health and Social Care Consulting report so that we can provide a safer environment to patients in our care."