McCann, Inquest Touching Upon The Death Of [2025] NICoroner 3 (07 February 2025)

McCann, Inquest Touching Upon The Death Of [2025] NICoroner 3 (07 February 2025)

The death of Mary Josephine McCann was caused by intra-abdominal haemorrhage due to splenic injury, sustained when she was thrown from her wheelchair during an emergency stop in a care home minibus. The inquest found that the wheelchair occupant restraint system was not effectively engaged, likely due to inadequate...

Source-derived case information.

Citation
[2025] NICoroner 3
Parties
Deceased: Mary Josephine ('Joyce') McCann; Next of Kin: Ms Elizabeth McAlea; Coroner: Coroners Service for Northern Ireland; Interested Party: Belfast Health and Social Care Trust (BHSCT); Interested Party: Somerton Care Home; Interested Party: Taxi and Bus Conversions Ltd
Jurisdiction
Northern Ireland
Judgment Date
07 February 2025
Procedural Posture
Inquest / Findings and Determination After Full Inquest Hearing
Outcome
Death by misadventure contributed to by neglect (failings in wheelchair restraint and hospital trauma assessment).
Legal Topics
Death in Care, Wheelchair Transport Safety, Hospital Treatment of Trauma, Elderly Patient Trauma Protocols, Occupational Health and Safety, Training and Equipment Standards
Coronial Law Health and Safety Law Medical Negligence Death in Care Wheelchair Transport Safety Hospital Treatment of Trauma Elderly Patient Trauma Protocols Occupational Health and Safety +1 more

Source-derived case record

Summary, issues, holding and outcome

More case intelligence is available

Unlock the full research layer for this judgment.

Full judgment text Downloadable case file Legal principles 2 Authorities cited 2 Party arguments 2 Amounts and remedies 3
Sign in to unlock

Parties

Mary Josephine ('Joyce') McCann

Deceased

Ms Elizabeth McAlea

Next of Kin

Coroners Service for Northern Ireland

Coroner

Belfast Health and Social Care Trust (BHSCT)

Interested Party

Somerton Care Home

Interested Party

Taxi and Bus Conversions Ltd

Interested Party

Procedural Posture

Inquest / Findings and Determination After Full Inquest Hearing

Legal Issues

  1. 1 Whether the death of Mary Josephine McCann was contributed to by failures in the securing of her wheelchair during transport
  2. 2 Whether there were deficiencies in the care and treatment provided in the Emergency Department and Fracture Ward
  3. 3 Whether the equipment and staff training met required standards for safe transport and care

Ratio Decidendi

The death of Mary Josephine McCann was caused by intra-abdominal haemorrhage due to splenic injury, sustained when she was thrown from her wheelchair during an emergency stop in a care home minibus. The inquest found that the wheelchair occupant restraint system was not effectively engaged, likely due to inadequate staff training and lack of formal procedures, resulting in her not being properly restrained. Additionally, the hospital failed to conduct a full trauma assessment or whole-body CT scan as indicated by best practice for elderly trauma, missing the splenic injury. Both failures contributed to the death.

Court Disposition

Death by misadventure contributed to by neglect (failings in wheelchair restraint and hospital trauma assessment).

Orders

  • Recommendation for all care homes to implement formal WTORS training and record-keeping.
  • Recommendation for hospitals to ensure adherence to Silver Trauma Triage Tool and lower threshold for whole-body CT in elderly trauma cases.