Tragic case of paralysed woman who refused care

ANGELA WRIGHT  l/r: Maritte, Stephen, Mark and Angela Wright.     9 October 2008

ANGELA WRIGHT l/r: Maritte, Stephen, Mark and Angela Wright. 9 October 2008

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MORE than 900 attempts were made by care professionals to help a 45-year-old woman who was paralysed from the neck down and died in squalid conditions at her Sheffield home.

Over several years Angela Wright “regularly resisted professional help that she felt was not warranted”.

She lived in her broken wheelchair, never changed her clothes, went to the toilet where she sat and ordered food by operating her computer with her mouth, eventually dying at her bungalow in Totley Brook Road in 2008 as a result of pyelonephritis, a urine infection, and kidney stones.

After a Serious Case Review, the case was described as “exceptional”. At the same time a report into the involvement of public agencies with Mrs Wright prior to her “premature” death recommends seven areas of action for the agencies involved and two national recommendations.

Mrs Wright is not identified in the report but is referred to as Ann. It says: “The inflexible demands that Ann placed on services were so stringent and so exceptional that her disappointment was inevitable.”

Agencies made more than 900 ‘interventions’ in trying to agree and deliver a care plan.

But Mrs Wright refused services and threatened legal action against various agencies and by law public agencies cannot impose services on unwilling adults who have the mental capacity to make decisions about their care.

Sue Fiennes, independent chair of Sheffield Adult Safeguarding Partnership, said the case was exceptional in that care was resisted from professionals who were committed to helping her. “This is a tragic case in that someone who, through their unwillingness to be cared for and engage fully with professional services, has died prematurely.

“It raises questions about an individual’s right to refuse care to their detriment when agencies believe services should be provided.

“This Serious Case Review makes clear that, regrettably, public agencies were hampered in giving her the support they wanted to for a variety of reasons despite the considerable efforts made to help her. We accept the recommendations in this report fully as they will further professionals’ understanding, support and wider knowledge sharing in this complex and unique area of adult social care.”

It suggests seven areas of action for the agencies who cared for the mother-of-three, including NHS Sheffield’s district nursing and community services departments and the council’s adult social care unit.

Staff could have decided it was in Mrs Wright’s best interests to intervene as her death approached, the report notes, if they had declared her incapable of making her own decisions under the Mental Capacity Act.

“It is possible that Ann lacked mental capacity in the final weeks of her life when her body weight plummeted. Although a service intervention during the final weeks could not have averted her death, it might have made it less harrowing. A best interests declaration, alongside a declaration of mental incapacity, would have made clear at a much earlier stage that professionals would not have had to engage in protracted negotiations with her.”

Mrs Wright’s son Stephen, 18 when she died, was her sole carer, having come to Sheffield while his older brother and sister lived in Bridlington. She would not let Stephen clean or provide for her health needs because Sheffield Council had taken him into care when he was 14 and she argued that a young boy should not be nursing his mother.

At an inquest last month, coroner Christopher Dorries recorded a narrative verdict and said the agencies were put in an “impossible position”.