During the inquest, the coroner emphasized the importance of understanding complex medical conditions, noting, 'Chloe died distressed and in pain due to a lack of proper understanding of her condition, myotonic dystrophy.'
The aunt of Chloe Every expressed deep concern during the inquest, stating, 'Chloe was agitated and in pain. She relied on sign language to communicate, demonstrating how critical proper care and understanding were for her health.'
The inquest raised serious concerns about the quality of care provided, with the coroner labeling the initial review findings as 'brief and glib.' It was noted that there was a failure to develop a coherent treatment plan for Chloe.
Chloe's family highlighted multiple gaps in her care, including the fact that specialist learning disability nurses were not involved, revealing a systemic neglect of patients with complex needs.
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