Medication ‘likely to be cause of death’ of dementia patient (82), inquest hears

MEDICATION prescribed to a dementia patient at St Saviour’s Hospital in 2018 was likely to be the cause of her death, a professor who reviewed the case has told an inquest.

Concerns have been raised about the course of treatment and medication given to 82-year-old Annick Sheehan as an inquest into her death began yesterday.

It was initially believed that Mrs Sheehan had died on 6 November 2018 from multiple myeloma – a form of cancer – and chronic renal failure. She was diagnosed with senile dementia, although this was not thought to have contributed to her death.

However, the senior clinical team at the General Hospital raised concerns about her care and the lack of investigation into the causes of her worsening mental state before her death. An inquest was requested and a post-mortem examination was carried out by Dr Helen Goulding, who found that the cancer was not the cause of her death.

An independent review of Dr Goulding’s findings was subsequently carried out by Professor William Roche, a consultant pathologist, who gave evidence during the inquest. After reviewing all of the evidence available to him, he concluded that the drugs given to her were likely to be the cause.

‘In my opinion, it is reasonable to conclude that the cause of death was the administration of terminal sedation, in the form of opioid and sedative drugs during the last week of Mrs Sheehan’s life,’ he said during the inquest.

The professor then turned his attention to Mrs Sheehan’s worsening delirium near the time of her death but added that his analysis was limited by the absence of ‘documentation of a systematic clinical approach to this problem’.

‘Whilst her dementia was undoubtedly going to worsen with time, the rapid deterioration in the last two weeks of her life appears to coincide with the use of sedative and opioid medication. I can find no explanation from the findings at autopsy for a cause other than this,’ he said.

‘Also, I cannot explain why it appears that an urgent end-of-life plan was made from the time of the multi-disciplinary report on 23 October.’

He added that on 30 October, Mrs Sheehan had been assessed as GSF Green – a term used to indicate that she still had months to live.

But, he said, it appeared ‘worsening delirium’ – an abrupt change in the brain that causes mental confusion and emotional disruption – had been used to justify the use of terminal sedation.

‘Although Mrs Sheehan’s delirium appeared to worsen and she was thought to be in pain, I can find no evidence of a structured plan to determine the cause of the worsening delerium of her pain,’ he said.

‘She was administered escalating amounts of the benzodiazepine drug midazolam and the opiate drug oxycodone.

He later added: ‘Following a telephone consultation, a palliative care consultant sent a fax, containing the following: “I am concerned that the agitation may not be pain and so opioids and midazolam may be making the situation worse. Cause of delirium could be opioids, urinary tract infection, hypercalcaemia [high calcium levels], further deterioration of renal function.” ’

Professor Roche then said that despite these concerns, Mrs Sheehan was administered terminal sedation by syringe driver and died.

The inquest continues. Relief Coroner Dr Martin Barrett is presiding.