Coroner to examine care home death

Assistant Coroner for Surrey, Caroline Topping, is considering a Prevention of Future Deaths report following the death of Daniel Lindsay, a 41-year-old man from London. Daniel lived at Ballater House Care Home in Surrey and passed away after choking due to undiagnosed oesophageal cancer in September 2023. While the coroner concluded that Daniel’s care did not directly contribute to his death, questions remain about the treatment of diabetic patients and the effectiveness of the care home's emergency alarm systems.

Daniel, who had learning disabilities and Down syndrome, entered the care home in November 2020. His family described him as a “gentle soul” who enjoyed watching wrestling on his iPad. During the inquest, it was revealed that Daniel experienced a hypoglycaemic event shortly before his death but was left unattended without a blood sugar reading taken. He was later found vomiting and was admitted to East Surrey Hospital, where he died the following day.

The coroner's findings raised concerns among Daniel’s family, who felt that signs of severe illness were not identified promptly, and communication about his health was lacking. Sarah, Daniel's cousin, expressed their shock and distress over his sudden decline in health, stating, “Daniel’s death came completely out of the blue. We believed he was fit, healthy and happy at his care home.”

The inquest unearthed issues surrounding the care provided, particularly regarding Daniel’s recurring symptoms, which some staff dismissed as exaggerated. As the family sought answers, they expressed concern that vital opportunities to act on health issues were missed, emphasising that “Daniel was vulnerable and relied entirely on others to recognise when something was wrong.”

Leigh Day solicitor Sarah Westoby, representing Daniel's family, highlighted the broader implications of their findings, noting that “the evidence heard at Daniel’s inquest has raised important issues around the role that families and carers play in supporting individuals who cannot communicate their care needs.” Daniel’s family hopes that his experience will increase awareness of the challenges faced by the most vulnerable members of society, potentially prompting necessary changes in care practices.

Throughout the inquest process, the family acknowledged the support they received from organisations like INQUEST, which aids families navigating similar tragedies, and expressed gratitude for the legal assistance they obtained to pursue justice for Daniel.