Co-written by Patricia Hitchcock
At inquest, neglect is now more broadly defined in medical cases, say Patricia Hitchcock and Ross Brain
MH WAS 38 years old when he died at Medway Maritime Hospital, Gillingham, Kent on 16 November 1999, of multi-organ failure due to sequestration of sickle cells during a severe sickling crisis. MH suffered from haemoglobin SC disease, a sickle cell disorder, and had a long history of admissions. He had suffered two lung crises in the mid-1980s but was in reasonably good health between crises.
He was admitted on 11 November with all the typical features of a painful sickling crisis and was treated with diamorphine and fluids. The following day, a Friday, he was still in some pain and had developed basal crepitations and a slight cough; the plan was to send sputum for culture and to treat any pyrexia with antibiotics. MH was not seen by a doctor over the weekend despite continuing pain and pyrexia and was not given antibiotics. On Sunday night, he collapsed with severe diarrhoea, fecal incontinence and vomiting. No doctor attended. By Monday morning, he had deteriorated considerably. Blood chemistry results showed raised urea, creatinine and potassium levels. Dextrose, insulin and calcium were given. Later that day, the pain was generalised in back, buttocks and abdomen and was reported to be far more severe than that experienced in previous sickling crises. His haemoglobin had dropped from 11 to 9.5 g/dl.
On Tuesday morning MH was confused and distressed and in severe pain; he was bleeding per rectum and had significant abdominal tenderness around the liver. Sickling, involving the brain and viscera, was diagnosed; haematology results returned in the late morning showed 5.2 g/dl. Six units were cross-matched. Before any blood had been transfused, at about midday, he collapsed with unrecordable blood pressure and fixed and dilated pupils. He was transferred to ITU, where he became tachycardic and a haemoglobin of 2.0 g/dl was recorded. There was ample clinical evidence of disseminated intravascular coagulopathy. Resuscitation was discontinued shortly before 14.30 and MH was certified dead at 17.50.
Coroner admits expert evidence
The coroner, who had initially intended to rely on the evidence of the treating doctor, was persuaded to admit expert evidence from Professor Sir David Weatherall, acknowledged by all parties to be the leading world authority on sickle cell disorders.