A WOMAN being treated at a hospital in Basingstoke died after choking on a sandwich because she did not receive adequate care, a jury has ruled.
Tracy Ann Young, 54, from Liphook, died in St Michael's Hospice, Basingstoke, on March 30, 2025 after being transferred there from Parklands Hospital.
Winchester Coroners Court heard that Ms Young, who had bipolar affective disorder, was a patient on Cherry Ward at Parklands Hospital, in Aldermaston Road, and was due to be moved to a seclusion room.
However, there were no beds available and she was instead moved to a de-escalation room.
Ms Young initially received one-to-one observations from staff, but this was increased to two-to-one.
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The inquest heard that standards were not met and she was not observed properly for various reasons, including staff using their mobile phones, and limited visibility of the room she was in.
The court heard that on February 18, Ms Young had kept a sandwich in the room, out of sight, and began eating it.
She collapsed from choking. It took three minutes from the time staff found her non-responsive to when they started CPR.
Her airway was blocked, starving her brain of oxygen, leading to hypoxic brain injury.
Ms Young was transported to Basingstoke hospital, where she stayed until March 26.
She was subsequently taken to St Michael's Hospice, where she died on March 30, with her mother beside her.
Concluding the inquest on Monday, October 19, a jury ruled that "Tracy's care lacked in significant areas."
The cause of death was recorded as hypoxic brain injury due to choking on food, with the jury concluding this was down to misadventure due to inadequate care.
Helplines
If you would like any help with bereavement, loss or mental wellbeing, here are some helpline numbers:
Call the Samaritans on 116 123 or go online at samaritans.org
Child Bereavement UK 0800 028 8840 childbereavementuk.org
Cruse Bereavement Care 0808 808 1677 cruse.org.uk
Survivors of Bereavement by Suicide (SOBS) 0300 111 5065 uksobs.org
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