Coroner's Finding: Bentley, Ena Ann

82y · Female·aspiration pneumonitis

An 82-year-old woman with cerebral palsy, epilepsy, spastic tetraplegia and blindness died of aspiration pneumonitis at North West Regional Hospital. She had been deteriorating since a February 2021 palliative care review. On 21 March 2021, facility staff called an ambulance when her breathing and temperature changed, she had not passed urine, and appeared in pain. She was diagnosed with aspiration pneumonia and admitted for end-of-life care, dying one week later. An allegation of forceful feeding 12 days before death was thoroughly investigated and found to have no substance. The death was natural and expected given her clinical trajectory. The coroner found no evidence of poor treatment or abuse at autopsy.