Finding into death of Janelle Maree Lavery

56y · Female·Complications of Angelman's syndrome - aspiration pneumonia

Janelle Maree Lavery, a 56-year-old woman with Angelman's syndrome, cerebral palsy, epilepsy, intellectual disability, dysphagia, and severe kyphoscoliosis, died of aspiration pneumonia following a one-month hospital admission. She experienced recurrent aspiration events, hypoxia, and hypercapnia episodes requiring multiple MET calls. Medical teams appropriately managed her complex condition, eventually transitioning to palliative/comfort care on 11 February 2024 after a final significant aspiration event. The coroner found the medical treatment provided at Box Hill Hospital and Wantirna Palliative Care was appropriate given her extensive comorbidities. The death was due to natural causes; her 'in care' status had no causal relationship to her death. This case highlights the challenges of managing aspiration risk in patients with severe neurological disability and dysphagia, emphasizing the importance of early palliative care discussions when aspiration becomes frequent and unpreventable.