A CORONER has ruled that care staff at a Hereford nursing home could not have prevented a resident from setting fire to himself.
Kenneth Bray, 65, died at Queen Elizabeth Hospital in Birmingham on September 9 last year – four days after he sustained serious burns at Manor Rest Home in Lower Bullingham.
Monday’s inquest heard the retired carpenter was diagnosed with chronic schizophrenia and a resident at the home for more than nine years. He previously attempted to set himself alight on two occasions and staff were becoming increasingly worried about his state of mind.
The home has a designated smoking room, but staff told the inquest they had to balance between preventing him having access to lighters and maintaining his quality of life.
“From May 2013, Ken deteriorated again and his behaviour became challenging,” said Julie Minnett, care manager at Manor Rest Home. “He demanded cigarettes from staff and sometimes became physically abusive by pushing and shoving them. We expressed our concerns and a review procedure started.
“But, if we made any attempt to stop him from smoking, it would have had a severe impact on his quality of life even if there had been a different outcome.”
The inquest heard that although in the past Mr Bray had been allowed to purchase a lighter, in recent times staff had tried to prevent him from having one.
However he got a lighter from another resident prior to the fatal incident.
Tanya Fogo, a care assistant at the home, said she noticed Mr Bray on fire on September 5 and staff used pans of water to try and put the flames out.
He sustained 50 per cent burns to his body and was flown to Queen Elizabeth Hospital, where he died.
The court heard a statement by Stuart Champion, an ex-employee of the home, claiming senior care manager Jackie Moffat told him Mr Bray set fire to his shirt collar the previous day.
But, Ms Moffat maintained that the alleged incident did not happen and she did not report anything about Mr Bray on the day in question. However, she did add that she was aware of two previous occasions when he tried to set fire to himself and asked her where in the kitchen should he “start the fire.” A review by the 2gether NHS Trust said that Mr Bray could still have got access to cigarettes, even if staff removed them, and was satisfied that it did all that it could to reduce any risks. Senior coroner Mark Bricknell said there was a “tremendous balance” to be struck when dealing with incidents of this nature and care staff made an appropriate one.
He recorded a verdict of accidental death.