Pensioner died after she was 'thrown' from chair

AN 84-YEAR-OLD woman died after she was thrown from a reclining chair when it "inadvertently" moved to the upright position, an inquest heard.

Nursing home resident Phyllis Butcher broke her hip in the accident at Staffordshire County Council-run Brighton House, in Silverdale, on June 22, 2008.

Doctors were unable to operate because of other underlying health conditions and she died in hospital the next day.

A Hartshill inquest heard yesterday that staff regularly put Mrs Butcher in the chair to relieve the pain of a bad back and pressure sores on her feet.

On the day of the accident, she had been in the reclined position for 20 to 30 minutes, when the chair slowly crept into the fully upright position while staff were busy making morning tea.

Support worker Beverley Sales said she had used the controller to put Mrs Butcher into a recline, before placing it in a side pocket of the chair.

She said shortly afterwards she turned around to see Mrs Butcher on the floor and the chair in the fully upright position.

She said: "I am not sure how it happened. I've worked at the home for 12 years and I have never seen it like that."

The inquest heard Mrs Butcher, who was unable to walk and had dementia, had been living at the home for five years when the accident happened.

Manager Yvonne Hunter said the home was no longer using chairs of this kind. The chair had been bought in 2003 and was manufactured by Pride Mobility.

Pathologist Dr Mark Rogerson said the cause of death was the broken hip. But he added that Mrs Butcher had been suffering from other underlying medical conditions, such as mini strokes, bronchitis, emphysema and kidney problems.

Health and Safety Executive (HSE) principal inspector Clive Brookes said a thorough examination of the chair had taken place and there was nothing mechanically wrong with the controller.

He said at the time of the accident, a small table was placed at the side of the chair with the controller in the pocket.

He said to make the chair go fully backwards or fully forward, pressure had to be exerted on the switch for 26 seconds, but tests had shown the controller could be operated on its own while in the pocket.

He suggested someone had walked past and put pressure on the table which had then brushed against the pocket.

Mr Brookes said the controller contained a key which could be removed to stop activation. But it had not been removed in this instance.

He said although no other accidents of this nature had been reported with regard to this particular product, HSE had referred the incident to The Medicines and Healthcare products Regulatory Agency (MHRA).

Mrs Butcher's daughter, Carol Myatt, of Lichfield Close, Silverdale, asked Mr Brookes: "If the key had been taken out, would the chair have operated?"

"No", he replied.

She added: "With my mum not being able to operate the controller herself, should the key have been taken out?"

"I understand your point entirely", Mr Brookes replied.

MHRA representative Jonathan Smith said before Mrs Butcher's accident, instructions accompanying the chair had not emphasised the safety importance of removing the key.

He said the manufacturer had since been contacted and the instructions modified.

He said: "If the key had been removed, it is unlikely that this incident would have occurred."

North Staffordshire assistant deputy coroner Margaret Jones recorded a verdict of accidental death.