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Thread: SYMPTOMS SUGGESTED BACTERIAL CONDITION, INQUIRY TOLD

  1. #1
    Senior Member Max's Avatar
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    SYMPTOMS SUGGESTED BACTERIAL CONDITION, INQUIRY TOLD

    SYMPTOMS SUGGESTED BACTERIAL CONDITION, INQUIRY TOLD




    A NINEWELLS consultant physician told a fatal accident inquiry in Dundee yesterday that the problems a Liff Hospital patient appeared to have after a fall could have been explained by the more obvious symptoms he presented rather than by a spinal cord injury.

    Dr Graham Leese was giving evidence before Sheriff Ian Dunbar at the inquiry into the circumstances preceding the death of 59-year-old James Mauchland.

    Mr Mauchland died at Ninewells Hospital on January 9, 2000, from a lung infection secondary to a spinal injury resulting from a fall on December 5.

    Dr Leese said there was nothing in the medical notes he received when Mr Mauchland was referred to him on December 6 that indicated a fall.

    Instead, the patient was said to be feeling increasingly unwell and increasingly drowsy with low blood pressure and was complaining of chest pain.

    The impression Dr Leese formed was that doctors who had already examined Mr Mauchland were not quite sure what was wrong with him and were seeking assistance to clarify his condition.

    The two main concerns for Dr Leese were the chest pain and a high temperature/low blood pressure condition that suggested a "significant sepsis" (pus-forming bacterial condition).

    Dr Leese said he thought the chest pains were too vague for a heart problem to be the cause but was concerned by the patient's "hugely swollen hand", no mention of which had been made on the medical notes that accompanied his admission to the consultant's ward.

    He took this to indicate that the hand condition had developed rapidly and to a stage where some function might be lost if something was not done quickly about it.

    Depute fiscal Stephen Kirk said that with hindsight it seemed that Mr Mauchland may have suffered a spinal cord lesion and he asked if he saw anything that indicated that.

    "No, is the answer," said Dr Leese.

    "There was no history of any head or neck trauma that I had received."

    Staff nurse Sandra Mitchell, who was on duty at Liff Hospital when Mr Mauchland is believed to have suffered his fall, said she heard a "bang" on December 5 but, although she and a colleague went to check, she could not find what had caused it.

    About 10 minutes later, a patient asked whether nursing staff were aware that Mr Mauchland was lying on the floor. She found Mr Mauchland lying near the skirting with a small graze on his chin and his arms by his sides and called in Dr Michael Cairns, the senior house officer that weekend.

    Under cross-examination by Mr Peter Grant-Hutchison, representing Mr Mauchland's family, Miss Mitchell said there was no system in place for carrying out regular checks of patients although any patients who were unwell would be given extra attention.

    She was asked how long Mr Mauchland might have lain on the floor if the other patient had not alerted staff and replied, "I don't know."

    Further cross-examined by Mrs Pamela Abernethy, appearing for Dr Cairns and Ninewells neurology registrar Dr Jane Pritchard, she agreed that the bang she heard could have been caused by a treatment door closing and the fact that Mr Mauchland was found on the floor could have been a coincidence.

    The inquiry continues.



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    Senior Member Max's Avatar
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    FAI TOLD OF NEUROLOGICAL EXAMINATION

    FAI TOLD OF NEUROLOGICAL EXAMINATION




    A 56-YEAR-OLD man was found to be suffering from two separate neurological conditions and probably also had a third, still unidentified illness, one of the doctors who treated him told a fatal accident inquiry into his death yesterday.

    Dr Jane Pritchard, who was then neurology registrar at Ninewells Hospital, was giving evidence on the sixth day of the inquiry into the death of Mr James Mauchland, who died at the hospital on January 9, 2000.

    Mr Mauchland succumbed to a lung infection secondary to a spinal injury resulting from a fall on December 5, 1999.

    Dr Pritchard said she examined Mr Mauchland for the first time on December 20, when he was very distressed, tearful and unco-operative.

    His reflexes bore the hallmarks of neuropathy (a disease of the peripheral nervous system) or of spinal shock, which happens following spinal injury, but not of a spinal cord injury of some weeks standing.

    It was rare, though not unknown, for spinal shock to last as long as three weeks, she explained.

    He moved in reaction to specific stimuli but, with hindsight, she believed these were just reflex movements, though at the time she couldn't be sure if he could move voluntarily or not.

    She saw Mr Mauchland again two days later when she told his sister that she thought he wasn't moving and Miss Mauchland asked if that could relate to his earlier fall.

    Miss Mauchland said she had been telling everyone about the fall for the past three weeks but no-one had listened to her, the doctor continued.

    The dead man's sister described in detail what she had been told about the fall and Dr Pritchard considered it could be relevant and decided an MRI scan of the neck area would be appropriate.

    "It was such a striking account that she gave, saying, 'He's fallen and he hasn't moved since he fell,'" she recalled.

    Before that, though the fall was mentioned once in the notes, there was no suggestion of a potential neck injury, she told the inquiry.

    This was the first time the fall "sounded hugely relevant," she said.

    Nonetheless, she thought his symptoms more typical of neuropathy and ordered tests on his arms and legs. These showed that he was indeed suffering from neuropathy and there was no way of knowing when that had started.

    The MRI scan the following day found the spinal injury, she told the inquiry.

    The neuropathy and the spinal cord injury were completely unrelated. She agreed that the presence of the two conditions simultaneously had complicated the diagnosis, adding, "I have never seen the two together in any other person."

    She said neither condition could account for Mr Mauchland's fever, low blood pressure and reduced periods of consciousness-the last being the symptom she had initially been asked to investigate-and she thought it probable that he was suffering from a third problem which has never been diagnosed.

    The problem was exacerbated by communication problems with Mr Mauchland, who had learning difficulties.

    Dr Pritchard said she spent about an hour reading Mr Mauchland's Ninewells medical notes before examining him for the first time.

    They were difficult to follow and were not filed in order, she said.

    She was not dealing with one continuous narrative of events from December 6 but was chopping back and forward between notes from different departments and it was difficult to follow the sequence of events.

    She saw only his Ninewells medical notes and was not given the notes from Liff Hospital, where he had fallen.

    Dr Pritchard said most hospitals refuse to transfer notes with patients.

    She would have looked at the Liff notes if they had been available because right from the first time she met Mr Mauchland she wanted more information.

    When Mr Mauchland was referred to her, a number of tests had been carried out on him already and she understood she was being asked if she could think of any further action to take to reach a diagnosis in his case.

    The doctors were keen for him to be transferred back to Liff because he wasn't getting treatment for his depression, which was also a major issue in his case.

    The inquiry continues.



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    MAN WOULD HAVE BEEN UNLIKELY TO SURVIVE, FAI TOLD

    MAN WOULD HAVE BEEN UNLIKELY TO SURVIVE, FAI TOLD




    THE RESUMED fatal accident inquiry into the circumstances surrounding the death of a 56-year-old man with learning difficulties at Ninewells Hospital was told yesterday that, even if damage to his spinal cord had been discovered at an earlier stage in his treatment after a fall, the tragic outcome could probably not have been averted.

    Dr Alistair J. Dorward, a senior consultant and director of adult medicine at the Royal Alexandra Hospital in Paisley, was giving expert evidence at the inquiry before Sheriff Ian Dunbar into the death of James Mauchland.

    Mr Mauchland died at Ninewells on January 9, 2000, having been taken there on three occasions from Dundee Royal Liff Hospital-where he was receiving treatment for depression-after doctors there became concerned about the state of his health following a fall in a corridor on December 5.

    Dr Dorward told Mrs Mary Robertson, representing a number of doctors who treated Mr Mauchland, that he had carried out a review of all the nursing and medical notes relating to Mr Mauchland's care both before and after his fall and said it was his opinion that the fall, and the initially undiagnosed spinal cord injury, had contributed to his eventual death but were only part of a far more complex scenario.

    He said that Mr Mauchland's existing, long-standing medical condition and state of health, which were exacerbated by malnutrition due to his ongoing refusal to take nourishment, meant that he was "a sitting duck" for bacterial infection.

    This, he went on, was made even worse by Mr Mauchland's "poverty of movement", which meant he spent long periods lying on his bed and refusing to get up, and his recorded behaviour of putting himself on the floor.

    Against this behavioural background, he said, it was quite reasonable and understandable that symptoms which in a "normal" patient might indicate the presence of a spinal injury were not recognised for what they were.

    Dr Dorward said that the spinal injury, while a matter of importance, was not in itself a life-threatening condition and that the medical staff and Ninewells were correct in the way they sought to treat a very ill and debilitated man who appeared to be suffering from a serious infection.

    With the benefit of hindsight the signs that could have pointed to spinal injury were present.

    Describing Mr Mauchland as having been in a "toxic confused state", Dr Dorward said this was a well-known condition affecting elderly or debilitated people suffering from infection and was particularly common amongst "little old ladies."

    He said that sufferers, once the cause of the infection was identified and the appropriate antibiotic given, generally made a speedy recovery.

    In Mr Mauchland's case, however, he said that the underlying ill-health meant that even with antibiotics his body was unable to fight the infection.

    Dr Dorward said that prior to coming to the inquiry to give his expert opinion, he had discussed Mr Mauchland's case with colleagues specialising in a wide range of fields including A&E and care of the elderly.

    None of them had come across a case like this and his view was that he "and probably 99.9% of physicians" would have treated Mr Mauchland in the same way as the medical staff at Ninewells did.

    As to whether the outcome for Mr Mauchland might have been different had the spinal injury been diagnosed immediately after his fall at Liff, Dr Dorward said, "I think he would have died anyway. I can't see anything in the process that he went through that was greatly wrong or inappropriate, medically speaking."

    "As a physician I would have to say the doctors were really on a hiding to nothing. The appropriate skills and dedication were put into this and, when it became clear he had a neck injury, the proper care was given.

    "As a clinical manager I think the system worked very well."

    Under questioning by Mr Peter Grant-Hutchison, representing Mr Mauchland's family, Dr Dorward agreed that the absence of any specific reference to the fall or to floppiness of the limbs in either the nursing or medical referral notes which went from Liff to Ninewells could be seen as a communication failing but said this in no way contributed to what followed.

    Mr Grant-Hutchison asked the witness what he would have done if, as has been stated in evidence to the inquiry, he had been the doctor in charge and had been made aware of the concerns apparently expressed by Mr Mauchland's sister regarding his condition.

    Dr Dorward said that, taking this version of events, he would have considered ordering a CT scan or neck X-ray to investigate the possibility of a neurological problem but he added, "That is assuming he would have been fit to undergo the procedures. Mr Mauchland clearly had other serious problems that needed to be dealt with."

    Dr Dorward told the inquiry that, in his opinion, Mr Mauchland's psychiatric problems were largely the cause of the chain of events that led to his death.

    "His psychiatric condition led to him becoming malnourished and depressed, which led to his fall which led him to being wide open to infection."

    The inquiry will resume on December 10.



    © D.C. Thomson & Co Ltd., Dundee, Scotland, UK. All rights reserved. These pages best viewed with Netscape Navigator 3+ and MSIE 3+ . Any questions, suggestions or comments can be emailed.

    ==============================
    "Those who seek to predict the future... might first look to the past. The past is a mirror -- and those who ignore its sometimes dark reflection, are doomed to repeat it... Will it be those seeking redemption who shall decide the future... or will those driven only by greed and envy shape our destiny? Even a hundred years later, the outcome is still very much in doubt. .." Outer Limits(Heart's Desire)



  4. #4
    Senior Member Max's Avatar
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    Hospitals review call after death

    Hospitals review call after death
    Hospitals should review how they deal with patients admitted with learning difficulties, a sheriff has said .
    The recommendation follows a Fatal Accident Inquiry (FAI) into the death of a man in Dundee whose spinal injuries went undiagnosed after a fall in hospital.

    Jimmy Mauchland, from Dundee, went to another hospital three times before the injury was diagnosed.

    He died a month after he collapsed in a hospital corridor in December 1999.

    'Out of sight, out of mind'

    Sheriff Ian Dunbar, in his 21 recommendations, said urgent consideration should be given to ensure specialist nurses were available to assist with patients who have learning difficulties.

    Mr Mauchland was found slumped in a corridor at Dundee's Liff Hospital after apparently suffering a fall.

    The 56-year-old had been undergoing treatment for depression for some time and was transferred to Ninewells Hospital the next day.

    But it was not until his third visit to the hospital that his spinal injury was diagnosed.


    The cause of his death a month later was given as a lung infection secondary to a spinal cord injury.
    Experts said the delay in diagnosing Mr Mauchland's injury was not unreasonable given the complex nature of the case.

    Sheriff Dunbar said doctors and nurses should pay attention to close family members and record notes of what they say.

    In his determination he said: "People with learning disabilities or a mental illness should be treated in the same way as other people, not in side rooms.

    "This lessens the chance of the person being 'out of sight, out of mind'."

    The charity Enable, which supported Mr Mauchland's family during the inquiry, said hospitals should review their training programmes.

    Chief executive Norman Dunning said that a lack of proper training and communication in Mr Mauchland's case led to discrimination in treatment.


    I will always wonder what the outcome for him would have been had he not had a learning disability and mental illness
    Betty Mauchland
    Mr Dunning said: "Enable call on the health service to implement the changes outlined to ensure that people with learning disabilities receive the same treatment as everybody else."

    Mr Mauchland's sister Betty said that if health trusts could implement just one of the recommendations they could save a life.

    But she was concerned there was no obligation on the NHS to accept them and introduce new working systems.

    She said: "What is the point in having a legal determination which has no power?

    "I cannot begin to imagine what it must have been like for him (Jimmy) and I will always wonder what the outcome for him would have been had he not had a learning disability and mental illness."

    A group of vulnerable people "whose voice is seldom heard" should have equality of health care, she added.

    NHS Tayside has promised to consider the sheriff's determination in detail and produce an action plan.

    A spokesman said some issues have already been addressed.

    Story from BBC NEWS:
    http://news.bbc.co.uk/go/pr/fr/-/1/h...nd/2835865.stm

    Published: 2003/03/10 11:30:50

    © BBC MMIII

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