How care home resident ingested large piece of plastic a mystery, says coroner
Mystery surrounds how a 57-year-old woman with severe learning difficulties died after swallowing a large piece of plastic at a residential care home in Co Down.
Donna McManus was found dead in her bed by a staff member days after a vomiting episode and appearing to suffer from abdominal pain.
A post-mortem examination found that Donna, who had lived at Bangor Nursing Home for over 20 years, had a piece of plastic measuring 24cm in her stomach.
Despite police investigations and an examination by the state pathologist, it remains unknown what the piece of plastic was, or how or when she swallowed it.
The court heard that Ms McManus had lived in a residential care home for most of her life and required round-the-clock care.
At the age of six she ingested a toxic substance that left her with severe learning difficulties, epilepsy, speech and mobility issues.
Her family members and nursing home staff had to puree her food and ensure that liquids were thickened as she had difficulty in swallowing.
The inquest into her death heard that in March last year, five days before she died, a staff member at the nursing home contacted Ms McManus's GP because she had been vomiting.
Staff were unaware she had swallowed the piece of plastic and despite an abdominal examination by Dr Philip Lavery, it remained undiscovered until after her death. "Trying to feel for a foreign body would be very difficult indeed," he told Belfast Coroner's Court.
Over the next few days, Ms McManus continued to vomit, which prompted a visit from Dr Lesley Cole.
The GP carried out a second examination. However, she told the court there was nothing that caused her concern and she thought at the time it might have been a stomach bug or inflammation.
Dr Cole added that while Ms McManus was in discomfort, there were no stomach masses.
The court heard that at around 9pm that evening, Ms McManus took her medication as normal.
Nurse Marianna D'Cruz checked on Ms McManus every hour; but shortly before 6am on March 8, the nurse discovered she was not breathing.
"She had been sleeping peacefully up until then," she said.
"But when I checked on her there was a strange colour on her face. I called for help and rang for an ambulance."
A post-mortem examination revealed a piece of plastic measuring 12cm was found in her stomach. State pathologist Dr James Lyness said that when unravelled it measured 24cm in length and 12cm in width.
He said it was brown and some of the edges had a serrated profile and the texture was crisp. He added that three pieces of plastic rolled out from one piece.
"Some have a saw-tooth pattern as if it had been torn from something," he said.
"Things like plastic from an apron or from sheeting to cover beds was suggested, but grease proof paper is my favoured."
While Ms McManus suffered from ingestive issues and was confined to a wheelchair, there was no history of her putting things in her mouth, nor was there was any evidence to suggest she was forcibly fed the piece of plastic.
Constable Gary Duffy explained to the court that he visited the nursing home on several occasions to look for an item that could possibly match what was found in Ms McManus's stomach, but despite finding a number of plastic items, it could not be matched.
Ms McManus's sister Jean Creighton revealed she had not known about the original cause of her sister's condition until after her death.
"The first we were made aware of her swallowing the toxic substance was when the constable read it out. It had not been spoken about in the family. Her demeanour was always very happy and very cheerful," she said.
Coroner Suzanne Anderson remarked that despite Ms McManus's difficulties, she was a cheerful and pleasant woman.
"Unfortunately, it's not possible to establish the source of the plastic or when she swallowed it," she said. "It was clear that despite her severe difficulties she was pleasant and was a much loved member of the family."