Sarah Huntbach, Senior Associate in our Personal Injury and Clinical Negligence Department, acted on behalf of Ms Sylvia Rushbrooke in proceedings before the Administrative Court under S.13 Coroners Act 1988. The proceedings related to an application to quash the original inquest decision and order a new inquest into the death of Ms Rushbrooke’s Mother, Renee Rushbrooke, who sadly died on 13 October 2016.

Ms Rushbrooke’s Mother, Mrs Renee Rushbrooke, suffered from dementia and was subject to a Deprivation of Liberty Safeguards Standard Authorisation (DoLS). She was resident in Wimbledon Beaumont Care Home just prior to her death and was admitted to Kingston Hospital on 20 August 2016, following a suspected adverse reaction to the drug Ramipril and breathing difficulties.

Whilst an inpatient at the hospital, it was discovered that Mrs Rushbrooke had three separate fractures to her leg. These fractures were unnatural and unexplained, and it was thought they were likely sustained prior to Mrs Rushbrooke’s admission to hospital. Neither the care home nor the hospital accepted that these fractures occurred at their respective premises.

Following discovery of the fractures, Mrs Rushbrooke was bedbound in hospital, which caused her breathing to deteriorate. She sadly died on 13 October 2016, and the reporting doctor gave her caused of death as “1a. Aspiration Pneumonia 1b. Stroke and 2. Atrial fibrillation, dementia”. No post-mortem was conducted.

As Mrs Rushbrooke had been the subject of a DoLS at the time of her death, the Coroner was required under S.1 Coroners and Justice Act 2009 to carry out an investigation into her death. The Inquest was held by Mr Chinyere Inyama on 27 October 2016, and he concluded that Mrs Rushbrooke died of natural causes.

Ms Sylvia Rushbrooke, represented by Sarah Huntbach and assisted by Sacha Hibbitt, made an application to the Court under S.13 Coroner’s Act 1988 to overturn this decision. This application raised concerns about the conduct of the inquest, which was riddled with procedural irregularities and ineffective investigation. The application to the Court further contended that the Coroner failed to consider Ms Rushbrooke’s concerns, including the contribution that Mrs Rushbrooke’s fractured leg and subsequent immobilisation had on her worsening condition, and concerns raised by the family about the care provided to her in the months before her death. In particular, a safeguarding investigation had commenced prior to the inquest to investigate the case of Mrs Rushbrooke’s fractures, but no consideration was given to adjourning the inquest pending the outcome of this investigation.

The application requested that the original inquest decision be quashed, and a new inquest be ordered into the death of Renee Rushbrooke.

The Respondent agreed that there was a real possibility that a fresh investigation and inquest may give rise to an alternative outcome to proceedings and consented to the application.

Lord Justice Hickinbottom and Mr Justice Garnham considered that in all the circumstances, it was clearly necessary and desirable in the interests of justice that a fresh inquest and investigation should take place. They granted the application and made an order to quash the original decision and order a new investigation take place into Mrs Rushbooke’s death.

You can read the judgment here.

This case has been the subject of academic comment, and has lead to wider lessons being learnt in the Coroner’s service as to the suitability of documentary inquests taking place where the Deceased’s family have concerns about the circumstances surrounding their loved one’s death. You can read more about this here.

For more information

Please contact Sarah Huntbach.