Prudence should have resulted in the caregivers of a mentally ill woman notifying supervisors their charge had been vomiting, inquest findings say.
However, coroner David Robinson stopped short of blaming anyone for the death of Dunedin woman Sharon Marie Shanks, saying the circumstances ``did not give the impression of there being a need for immediate medical attention''.
Ms Shanks (48), was in supported accommodation provided by Pact when she died in July 2016.
Subject to a compulsory treatment order, Ms Shanks suffered from a range of mental health issues: the order meant an inquest into her death was mandatory.
Pact staff had reported Ms Shanks had been unwell, with vomiting and diarrhoea, in the days leading up to her death.
She last spoke to caregivers on the night of July 14, complaining of feeling unwell and having tried to make herself vomit.
Ms Shanks was found dead in her bedroom next morning.
Mr Robinson found in the days leading up to her death Ms Shanks appeared well.
``Had medical assistance been called, the need to remain hydrated would likely have been emphasised ... that is entirely speculative, though.''
Mr Robinson
found that the seizure which killed Ms Shanks was death by natural causes, and made no formal recommendations stemming from her death.
