Inquest hears drug dose given to Jersey dementia patient was not abnormal
An inquest into the death of an elderly dementia patient in Jersey heard that the type and dose of drugs she received were not abnormal.
82-year old Annick Sheehan died on 6 November 2018, whilst an in-patient at St Saviour's hospital.
On 30 January an independent expert, Prof William Roche, suggested she had died from the drugs she was given, rather than blood cancer, which was the official cause of death.
Dr Tim Harrison, a palliative care consultant today ( January 31) said he did not accept that the type and dose of drugs she had received were out of the ordinary.
Mrs Sheehan was admitted to St Saviour's hospital suffering with dementia, but also had several other medical conditions including blood cancer, kidney disease and type two diabetes.
Yesterday, Prof Roche, said Mrs Sheehan had died of terminal sedation, or the combination of increasingly higher doses of sedative drugs which had been administered to her in the week before her death.
He voiced concern over the lack of effort to establish any potential physical cause of her rapid deterioration.
Mrs Sheehan had fallen a week before her death and a CT scan, conducted after her death, showed a number of rib fractures.
A key question for the inquest has been whether the physical wellbeing of mental health patients is given the appropriate care.
Whilst Dr Harrison did not agree that Mrs Sheehan had received terminal sedation, as suggested by Prof Roche, he did agree that there seemed to have been a lack of consideration of other potential factors that could have contributed to Mrs Sheehan's pain and agitation.
Dr Harrison also pointed out that there seemed to have been a lack of communication between the different teams responsible for Mrs Sheehan's care.
Dr Harrison report included a number of recommendations for improvement, including:
When a patient's overall health needs and goals of care change, a full multi-disciplinary team meeting, including all key professionals, agencies and family members/carers must take place to agree a multi-disciplinary/multi-agency care and treatment plan.
Patients who require assessment for acute physical health problems should be transferred to the General Hospital in the same way as any patient referred from a non-acute hospital setting. Likewise, any patient requiring clinical investigations should be treated as any other Health and Community Services in-patient.
Introduce a system of physical health liaison to support mental health in-patients acute and chronic physical health care needs. In the short term identify a pathway for physical health liaison into the mental health inpatient units form the General Hospital site. Liaison should include nursing and medical professionals.
Dr Miguel Garcia, Jersey's Associate Medical Director for Mental Health told the inquest that many changes are already in the process of being implemented and that he is passionate about achieving greater parity between the physical and mental health offering in the island. He added that this is a challenge that is not unique to Jersey.
On day one of the inquest, attendees heard from Dr Abdul Shah, a psychiatrist at Beech Ward and Dr Glyn Thomas, a locum consultant in old age psychiatry. Both confirmed that it can be difficult to get the required medical support for mental health patients.
Dr Garcia told the inquest that it can be difficult for hospital staff, less familiar with mental health patients, to manage them appropriately in a hospital setting.
Dr Garcia did add, however, that he had never had a patient whose need for hospital treatment had been refused.
Ms Rebecca Sherrington, Jersey's Chief Nurse confirmed that a number of lessons had been learned from the case and that Dr Harrison's recommendations had the full support of all services.
The inquest also heard from Dr Winspear, the last GP to see Mrs Sheehan prior to her death. He confirmed his genuine belief at the time that she displayed all the typical symptoms of someone suffering from blood cancer.
The inquest reconvenes on March 16, where the evidence of the final three witnesses will be heard.