MRS. MURIEL MAGUIRE
I am Mrs Muriel Maguire, mother of Jacqueline Charlotte Assumpta Maguire, referred to by everyone who knew her as ‘ Jackie.’  I have written this with the assistance of my son, Kenneth Maguire, and we write it on behalf of all of Jackie’s family.

WHAT I AM TRYING TO ACHIEVE
I ask for help with funding so I can apply to the European Court of Human Rights in Strasbourg against the dismissal of my appeal to the Supreme Court.

The Supreme Court decided the coroner at Jackie’s inquest did not err in how he came to his decision that the jury should not be allowed to identify and comment upon what I regard as the many failings that led to Jackie's death.

As a result of the coroner’s decision, the jury were only allowed to say that Jackie died by reason of natural causes and, therefore, the many failings were not identified and recorded in the Record of Inquest.

The coroner decided as he did because he was not satisfied the state’s duty to protect life under Article 2 of the European Convention on Human Rights applied in Jackie’s case.

If I succeed in Strasbourg, the court will have decided that Article 2 did apply so that the state did  have a duty to protect Jackie’s life, and which it breached because there were failings for which the state was responsible which led to her death. This means the true circumstances of Jackie’s death will finally have been established and recognised and justice obtained for our Jackie. Further, future inquest juries will, in cases like Jackie's, be allowed to identify failings and make judgmental findings, and these will become part of the Record of Inquest in those cases as well. In this way, there will be accountability and lessons will be learned which will help to prevent such tragic deaths in the future. This is so important.

WHO MY DAUGHTER JACKIE MAGUIRE WAS
My daughter, Jackie Maguire, died on 22 February 2017 after repeated failures to get her access to healthcare. She was just 52. She lived with Down’s syndrome and she had learning disabilities. She was placed in a care home in St. Annes, Lancashire, by the council. She lived there under a Deprivation of Liberty Safeguard authorisation obtained under the Mental Capacity Act because she did not have capacity to make decisions about most things that affected her, including medical care, so that such decisions had to be made on her behalf in her best interests. Her ability to communicate was limited . She was bent over to about 30 degrees when on her feet owing to long standing scoliosis which caused her constant back pain. She had to use a wheelchair outdoors. She was extremely vulnerable.

WHAT HAPPENED TO JACKIE
What follows now are the events, including what I regard as failings, that led to Jackie’s death and which the jury were not allowed to identify, comment upon, and include in the Record of Inquest :-

1.  On 20 February 2017, in the evening, Jackie was vomiting and was found to have a  high temperature. She requested a doctor but care home staff did not act on this request. So she got worse.

2. On 21 February, in the morning, Jackie  was experiencing breathing difficulties. She again asked for a doctor. Again, care home staff did not respond.

3. Later on 21 February, at 2.15pm, Jackie suffered a loss of consciousness in the shower room. After delay, at 2.55pm the staff telephoned the GP surgery rather than 999 which suggested contacting the 111 service.

4. The 111 service then failed to contact the 999 service and request ambulance attendance for Jackie despite the life threatening symptoms that were reported to them ( loss of consciousness, vomiting of blood and severe stomach pain ). Instead, they said to contact the GP surgery again and say a GP should come to see Jackie within 2 hours.

5.  The staff contacted the GP surgery who asked if Jackie could not be brought to them. They were told that Jackie was too poorly.

6.  The GP then would not attend but telephoned the care home at 5pm and misdiagnosed Jackie with a urinary tract infection ( UTI) and prescribed an antibiotic. He carried out a poor triage. At the inquest he conceded he should have visited Jackie.

7.  As Jackie became increasingly ill she wanted to lie down.  At 7pm she tried to make her way upstairs to her bedroom. She endured repeated episodes of loss of consciousness and collapse on the staircase and in the bathroom at the top of the stairs next to her bedroom.

8.  The staff again called 111 rather than 999. This was at 7.15pm. Eventually an ambulance crew attended at 8.05pm but they would not take Jackie to hospital because they thought she was refusing to go and they were reluctant to manhandle her-  this notwithstanding they knew Jackie did not have capacity to refuse to go to hospital and it was in her best interests to go. 

9.  The ambulance crew telephoned an out of hours GP at 8.30pm. There was poor communication between them. Ultimately, the out of hours GP said that to try and get Jackie out to the ambulance “ at this time of night is a bit daft.”  At the inquest, this GP admitted carrying out a poor triage. She said had she asked the paramedic for Jackie's observations as she should have done she would have recommended  "immediate hospital admission."

10.  Ultimately,  the ambulance crew left without Jackie who remained in the care home overnight with just one member of staff on duty with no medical training.

11.  By the morning of 22 February,  Jackie was desperately ill. At 8am, she was unconscious on the bathroom floor when the care home manager arrived after several days off work and called 999. An ambulance attended and found Jackie to be in shock. They took Jackie to Blackpool Victoria Hospital where she arrived at 9.30am.

12. At the hospital, Jackie was found to be in septic shock. Doctors, thinking the source of Jackie’s sepsis was a UTI ( it wasn’t ), never investigated whether that was so .They also failed to diagnose that Jackie had a perforated stomach ulcer and peritonitis, and pneumonia - these were the causes of death on Jackie’s death certificate, and the true source of her sepsis. Jackie also never received the recognised treatments for the septic shock itself, nor the monitoring that septic shock requires. She remained in the A&E department all day as there were no beds for her elsewhere in the hospital. At 6.30pm, nine hours after she arrived at the hospital, and not being attached to monitoring equipment, a nurse chanced upon Jackie in cardiac arrest. She could not be resuscitated and she was pronounced dead at 7.40pm.

13.  And Jackie did not suddenly become ill in the last 2 days of her life. In 2015, owing to a serious prescribing error by her GP,  Jackie's stomach was left insufficiently protected against the Naproxen medication she was taking for her back pain -  Naproxen is well known to cause stomach ulcers. This prescribing error was never corrected.

14. In December 2016,  her two appointments at Blackpool Victoria Hospital were erroneously cancelled by care home staff, which meant Jackie was discharged by the hospital without proper investigation of her stomach pains, of which she continued to complain from time to time until her death. 

15.   For the last 10 days of her life she experienced diarrhoea, blood spotting, an increasing sore throat and husky voice, and was increasingly refusing her food - but the care home staff did not attempt to obtain medical help for her even though she was clearly ill.

ITV AND BBC
Following the Supreme Court's judgment, I was pleased to receive an invitation from ITV's Granada Reports programme to talk about Jackie's case because bringing Jackie's case to the attention of the wider public could help to prevent deaths like hers in the future. If you wish, you can see the interview at itv.com/news/granada/2023-07-19/mum-of-disabled-daughter-who-died-in-care-home-to-continue-legal-fight-to-echr  or Google 'Jackie Maguire Granada Reports.'

I was also grateful to receive an invitation from BBC Radio 4's World At One programme and my conversation with them was broadcast on 7 July 2023 at just before 1.28pm. The link to the programme is   bbc.co.uk/programmes/m001nh1p ( this link may not last indefinitely).

MIND, AND THE EQUALITY AND HUMAN RIGHTS COMMISSION
It was also gratifying to receive the support of Mind, and the Equality and Human Rights Commission ( EHRC) , who both intervened in the appeal in the Supreme Court.  After the court's judgment dismissing the appeal, the EHRC said :-

“We argued that people like Jackie Maguire, who are detained because they lack the capacity to decide their care and treatment and where they should live, should be owed the same level of human rights protection as other vulnerable groups, such as those detained in mental health hospitals, prisoners and police custody. This would have allowed the jury at Ms. Maguire’s inquest to comment on the alleged failings of those caring for her.”

Noting the Supreme Court rejected this argument and decided Jackie only had the same human rights protection that apply to the general population,  Marcel Boo, the Chief Executive for EHRC,  expressing his disappointment said  :-

  " Jackie Maguire's death was deeply tragic. We believe that Jackie should have had the same human rights protection as others deprived of their liberty, where the state has additional responsibilities for them. We will continue to argue for further protection for the most vulnerable members of our society, and hope that in the future deaths like this can be prevented." 

If you wish to read the full EHRC article, the link is equalityhumanrights.com/en/our-work/news/ehrc-'disappointed'--supreme-court-care-home-judgment and scroll down to the news item dated 21 June 2023.

SUPREME COURT JUDGMENT
The summary of the Supreme Court's judgment, and the judgment itself ( this is lengthy and complex reading ), can be found on the Supreme Court's website www.supremecourt.uk/cases/uksc-2021-0038.html and scroll to 'Judgment details' at the bottom of the page.

WHAT JACKIE WAS LIKE
Jackie was a wonderful daughter. She could communicate by uttering one or two words at a time which, together with gesturing and the strength of her personality, meant she usually could make herself known to those who knew her well. She was very independent-minded. She was mischievious and had a wicked sense of humour. In her younger days, she liked nothing more than to see her brothers and sisters get told off. She was the life and soul of the care home and was very popular with the other residents. She had her own sitting room but joined the other residents for meals and social occasions. She always really enjoyed her birthday and Christmas. She liked her food. She loved music - Michael Jackson and Abba were big favourites. She liked to watch TV. She liked looking at fashion magazines. She liked to be taken shopping locally in her wheelchair. She led as useful and fulfilling a life as living in a care home with Down’s syndrome , her physical limitations, and back pain would allow.

I was very touched by the number of condolence cards I received after her death and by the sentiments expressed. To think Jackie’s life ended the way it did, the dreadful last 48 hours, the pain, the suffering. She lost consciousness so many times. She wouldn't have known what was happening to her. She did not deserve to die the way she did - nobody does- but she was badly let down by so many people with responsibility for her care. The Supreme Court’s judgment is the judgment , but not the right one for our Jackie and people like her. Had she not had Down’s syndrome we wouldn’t even be talking about this now, there lies the difference.

FUNDING

To go to Strasbourg,  I will need to raise as much money as possible to cover the costs of legal representation. No legal aid is available for the initial stages of the case.  I would like to raise £5,300 as an initial target so that the application can be made to the  Court and to cover the costs of solicitor and counsel.

 If the court then decides that the application is admissible and proceeds to hear the case,  it will decide on what the future directions will be and how the case will be heard.  We will not know the full details of this until the decision on admissibility is reached, however we anticipate that we would need to raise roughly £20,000 to cover the costs of the case for this stage.

Legal aid is potentially available for this stage through the court if the application is deemed admissible, however these funds are very limited and would not cover the full costs of representation.

 Any excess funds would be donated to other Crowdfunders or to charity.

 We have to file our application with the court by 20 October 2023.

THANK YOU
Thank you very much for reading this and for any donations you feel able to make. With your help, if we succeed in Strasbourg, not only will we get justice for Jackie but this will undoubtedly help to prevent deaths such as Jackie’s in the future and, very importantly to me and all of Jackie’s family, her death will not have been in vain and, perhaps even, the pain of her passing may ease just a little.

Please share this page if you can.

Mrs Muriel Maguire