A severely disabled girl who accidentally hanged herself as she fell from her bed at a Sydney respite centre should not have died, an inquest has found.
Melissa Standen wasn’t properly assessed by nursing staff and was placed in the wrong type of bed, leading to her death.
Now the coroner wants stricter guidelines to improve hospital bed safety.
For Melissa’s family there were tears of grief and relief as the coroner delivered his findings.
“We hope this will ensure, unlike our Melissa, no other child with a disability will be placed at risk,” Melissa’s mother Tin Ho said.
Melissa suffered severe disabilities and needed 24-hour care.
On occasion, her family relied on Allowah Presbyterian Children’s Hospital in Dundas for respite.
On Tuesday the private facility was blamed for the 13-year-old’s death.
“Due to failures in systems in place at the hospital, Melissa fell from her bed,” State Coroner Les Mabbutt found.
“Melissa’s death was preventable.”
The coroner ruled that nursing staff weren’t properly trained and Melissa’s bed was unsuitable.
Despite being assessed as immobile, she was able to move around the bed.
She fell through the railings, her t-shirt got caught and she choked.
The coroner didn’t direct any recommendations to the hospital, saying changes had already been implemented.
However, he did call on NSW Health Minister Brad Hazzard to ensure strict guidelines are developed in all NSW hospitals to improve bed safety for children with disabilities.
A spokesperson for the Health Minister told 7 News: “While this tragic event occurred in a private hospital, he will ask NSW Health to consider the coroner’s recommendation.”
“Children with high needs deserve better and improved care to keep them safe,” Mrs Ho said.