Christine Ann WILLIAMSON · Prevention of Future Deaths report

On the 13th November 2012 I commenced an investigation into the death of Christine Ann WILLIAMSON aged 62 years. The investigation concluded in an inquest on the 16th December 2013. The conclusion of the inquest was ‘The deceased died from a physical assault by her husband who by reason of his lack of mental capacity was unaware of his actions or its consequences. If earlier action had been taken the deceased may have been protected and her death was preventable’.

The medical cause of death was:

Ia Subdural Haematoma
following mild blunt head trauma
Ib Warfarin therapy for recurrent deep vein thrombosis

Mrs Williamson was 62 years of age when she died following an assault upon her by her husband who was suffering from advanced onset of Alzheimer’s dementia and was unaware of his actions or its consequences.

The assault on the 18th October 2012 was the last of 5 recorded assaults between the 6th December 2011 and the 18th October 2012.

(1) A referral and assessment should have been made that the deceased was a Vulnerable Adult at risk from her husband. Such a referral and assessment could have been made before or after April 2012, but most notably on or around the 2nd - 4th April 2012 when the deceased’s GP made a direct referral to social services. This should have led to an assessment as a Vulnerable Adult but if not as the victim of domestic violence.

(2) Had such an earlier assessment as a Vulnerable Adult been made then discussions would have taken place with all concerned with every having significant information sharing it with others. This would have increased the likelihood that preventative measures would have been put in place as the deceased being better or fully informed as to the increased risk she was putting herself in by continuing to live with her husband whose condition was deteriorating. The best illustration of this lack of shared information is that the evidence given at the Inquest when all relevant witnesses were present, should have taken place in a meeting before the situation became critical.

(3) An independent domestic homicide review has been undertaken and the author of the report gave evidence at the inquest including authors or representatives of the relevant individual management reviews. Recommendations were made which I endorse.