Deep bed sores would have been painful leading to disabled woman's death, mother's trial hears
WARNING: This story contains disturbing details
Ten bed sores — some so deep, they exposed infected bone — would have caused significant pain to a disabled Calgary woman in the months leading to her demise, an expert testified at the trial of the woman's mother on charges of criminal negligence causing death.
Melissa Couture, 38, died from choking in April 2016. She had severe developmental disabilities, functioning at the cognitive level of a three- or four-year-old, as well as cerebral palsy and suffered from hearing loss, visual impairment and body stiffness, according to the agreed statement of facts.
Her mother, Patricia Couture, 70, went on trial before provincial court Judge John Bascom in Calgary on Tuesday.
Dr. Chester Ho told court Wednesday that he used Alberta Health Services records, dental records, photos and the autopsy report to compile his own findings, which include details on the pressure sores suffered by Melissa.
She was in a severe state of malnutrition and had lost half her body weight in the last four years of her life, court heard.
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She weighed just 51 pounds at the time of her death.
Ho testified Wednesday that the bed sores would have made it incredibly painful for Melissa to sit up.
Some of her bones were infected because of the ulcers and the tissues around the ulcers was necrotic.
"She was probably in a lying position most, if not all, of the time," Ho wrote in his report.
He said the ulcers could have contributed to her death. Melissa died from choking so the pain of sitting up may have exacerbated her issues with aspirating food.
Because the ulcers were due to poor care, malnutrition, dehydration and immobility, Ho testified that he believes they would be avoidable and Melissa's death could have been prevented.
Melissa may have choked on meat
Medical examiner Dr. Bamidele Adeagbo found Melissa died from "choking by foreign substance" but he also said "the possibility of physical neglect including deprivation cannot be ruled out."
A yellow-green gelatinous substance was found inside Melissa's mouth and trachea, which Adeagbo confirmed was consistent with meat.
On top of the ultimate cause of death, Adeagbo also detailed numerous findings of concern including the infected pressure ulcers, pneumonia likely caused by aspirating food, an "extreme lack of oral care" and other evidence of "lack of basic self care."
He said Melissa's condition would have required 24-hour care, even for simple tasks like eating.
Though she's been described in court as having cerebral palsy, Adeagbo agreed with defence lawyer Andre Ouellette that the condition is often used as a catch-all for various neurological disorders. More specifically, Adeagbo said it was likely Melissa suffered from pseudo-Hurler syndrome, a genetic disorder affecting cognitive and physical abilities.
No health care for 4 years
On Tuesday, paramedics described finding Melissa lying on her living room sofa, surrounded by the smell of feces, urine and decay.
Patricia was her daughter's primary caregiver. There are no records of her seeking help from local support services for people with disabilities.
The last record of any health care received by Melissa was a 2012 hospital visit, during which time it was noted that she had lost 15 pounds, had difficulty swallowing and was newly incontinent.
That was likely the turning point for the disabled woman, according to Dr. Maitreyi Raman's testimony on Tuesday.
Chief Crown Sue Kendall and prosecutor Kyra Kondra said they intend to close their case after five witnesses on Thursday. Defence lawyer Andre Ouellette has indicated he plans to call his client to testify in her own defence on Friday.