Warning signs that a retired army officer with dementia who killed his wife was struggling to cope with her care were missed by health professionals, a report has found.
A domestic homicide review into the death of Doreen Virgo, 89, who died at Grays Fair Court respite care home in New Costessey in July 2019, makes a series of recommendations to avoid similar tragedies.
Her husband Mick Virgo, 81, with whom she lived in Mill Street, Buxton, was initially charged with her murder but was found unfit for trial due to his dementia.
However in January 2020 a jury unanimously ruled that he had strangled his wife after attempts to kill her with rat poison and a shower head failed.
The multi-agency review into the circumstances surrounding her death found no evidence of domestic abuse saying they were “a devoted and caring couple” who wished to “maintain their independence as long as they could”.
Mrs Virgo, who suffered from multiple sclerosis, had to be taken to the care home about a month before her death following a fall.
The review report finds that Mr Virgo had become increasingly confused, vague and forgetful but that “none of the professionals who noted his behaviour sought to delve deeper into this”.
“As an older person his apparent muddled thinking, confusion, and forgetfulness should have raised questions about his health and his mental capacity,” it adds.
The failure to undertake a carer’s assessment was significant, adds the report, which refers to the couple as 'Richard' and 'Daisy' rather than the couple's real names.
It reads: “Not only because Richard was struggling with maintaining his care of Daisy safely, and he had his own health problems, but the assessment may have identified mental capacity issues which seem to have been emerging in the months leading up to Daisy’s death.”
Multiple calls to the ambulance service were “an indication of unmanaged crisis for which there was no planned coordinated response to handle Daisy’s complex health needs, and Richard’s increasing inability to cope”.
Norfolk County Community Safety Partnership (NCCSP), which commissioned the review, said its findings “highlighted the necessity for professional curiosity and assessment in recognising carers, carer stress and the mental well-being of carers” particularly where “the physical frailty of a carer limits their ability to look after a loved one”.
Mark Stokes, NCCSP chair, said: “A DHR is never an easy process to go through but it is important that we take these opportunities to scrutinise the circumstances that led to it and how we can all move forward, confident that improved practises and ways of working are in place across all of the agencies involved.”
What the review recommends
The domestic homicide review makes a series of national and local recommendations, including:
• The Department of Health should provide guidance and examples of good practice for
practitioners on assessing risk of harm where carers are affected by dementia.
• All practitioners working with adults should be aware of the signs and symptoms of dementia.
• Guidance should be changed to include the need for practitioners to re-offer support and assessment at intervals as needs change over time.
• GP practises should ensure that a system is put in place to identify patients who have caring responsibilities, and this is highlighted on their patient record.
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