Mrs Marcia Clark was an 83 year old woman who died at Manning Base Hospital Taree, New South Wales, on 20 July 2014. Three day prior to her death, she was found by ambulance officers in an extremely poor condition at home. Following some indication that Mrs Clark had been the victim of elder abuse, a report was made to the appropriate service. The inquest into her death focused on the adequacy of the care she received prior to her admission on 17 July 2014.
On 17 July 2014, ambulance officers attended the home of the deceased. She had lost a lot of weight and was in extremely poor hygiene. Her bed and house were unsanitary. The deceased was taken by ambulance to Manning Base Hospital Taree. She was incoherent and in pain. She had some pressure sores, some deformity, muscle wastage and multiple joint contractures. She was dehydrated and malnourished. Doctors at the hospital indicated that Mrs Clark was 'extremely unwell and at high risk of dying during her admission'.
The hospital determined that treating Mrs Clark's injuries would have involved an extensive debridement. She was also at a high risk of death or complications if the required anaesthetic for the procedure was administered. She was therefore placed on palliative care without resuscitation or intubation. Having decided that the deceased may have been the victim of elder neglect, the hospital contacted the Elder Abuse Helpline.
On 20 July 2014, Mrs Clark died, aged 83. An autopsy concluded that the direct cause of her death was the combined effects of severe malnutrition and septicaemia secondary to an infected sacral pressure sore. The focus of the inquest was on how the condition of the deceased deteriorated to the extent that it was on her admission to Manning Base Hospital.
The inquest heard that the deceased's daughter was her carer. Evidence before the inquest showed that her daughter:
- struggled to cope with caring for her mother;
- had been unwell with a virus;
- lacked insight about her mother's condition and was unable to really explain why she did not get her medical help earlier;
- was living in poor physical and domestic conditions herself;
- together with her mother, did not like visitors in their house and tried to close off their home from the outside world;
- disappeared in July 2016 and her body discovered in bushland in September of that year;
- could have been the victim of carer stress which is a condition commonly seen in carers of older people.
Findings and Recommendations
The Deputy State Coroner, Teresa O'Sullivan, found that Mrs Clark's GP did not keep adequate records of his consultation with her, nor did he include sufficient details that could have assisted the court in gaining insight into her presenting problems and treatment plan. Further, the same GP saw the deceased's daughter on a number of occasions but there was no evidence that he inquired about the condition of her mother. It was noted however, the deceased's daughter, in any case, was unlikely to volunteer details of her mother's health, given evidence that they kept to themselves.
The Deputy State Coroner did not attribute malicious intent to the deceased's daughter, but found that she was not up for the challenging task of being the sole carer of an elderly person. She found that Mrs Clark died from natural causes after a period of being neglected by her carer.
The inquest examined the role the Elder Abuse Helpline could have played in achieving a better outcome for the deceased. It was noted that the Helpline could only refer cases of concern to mediation or other forms of dispute resolution. The Deputy State Coroner encouraged the plans already in place for the Helpline service to be able to provide more than just advice and referrals but also follow up to ensure that people are being linked with services they need.
The Deputy State Coroner noted that the Helpline was not an investigatory body. Where there are concerns that an older person is experiencing abuse at home, the police is engaged to conduct a 'concern for welfare check' on that person. The Deputy State Coroner stated that this was not a desirable situation because the police are not qualified to act as social workers or health professionals. They are not well-equipped to conduct medical or psycho-social reviews of older persons in their home, nor are they 'the appropriate service to investigate more insidious and less obvious forms of elder abuse or neglect'. There is therefore, the need for some specialised service to be put in place, with the capacity to enter the home of an older person and investigate the quality of care they receive.
It was further found that the deceased required an in-home assessment to determine her suitability for ongoing residence at her home. The inquest heard that this service was available in 2014 when Mrs Clark died but there was no evidence that she received it or that her carer had requested it. It was submitted that changes to how these assessments are conducted have decreased its efficiency in many cases. There was a 9 month delay between approval of such services and their commencement. The Deputy State Coroner stated that such delay put vulnerable elderly people at risk.
Finally the Deputy State Coroner stated that the death of Mrs Clark highlighted the possible consequences of older people retreating from public view into their homes and also the need for family members, medical staff and others to be curious about how carers are actually coping underneath their physical appearance. It also shows the need for the best interest of the older person to be placed at the centre of decision making around their care if they are unable to make these decisions themselves.