Finding into death of Maria Elizabeth Valler

56y · Female·asthma

Maria Valler, a 56-year-old woman with intellectual disability and autism who was living in Department of Health and Human Services (DHHS) supported accommodation, died from acute asthma while returning from a walking excursion. She had been prescribed both preventer (Seretide) and reliever (Ventolin) medications, but her Ventolin was not brought on the outing. Critical findings include: disability support workers had limited and variable awareness of her asthma diagnosis; staff were unaware of any asthma management plan; the plan itself was deficient, using an outdated 2009 template with unclear exacerbation instructions; and staff failed to recognise basic first aid steps for acute asthma when Maria became 'blue in the lips' with inability to support her bodyweight. Rather than seeking emergency help, she was placed in a minibus to drive home. The coroner identified systemic failures in staff training, medication management, and clinical recognition of deterioration. The DHHS has since implemented remedial actions including engaging Asthma Australia to develop improved templates and expanding staff training programs.