What is the value of a few months of life? Palliative care and the over-administration of narcotics and benzodiazepines for comfort.
Isobel had metastatic breast cancer. She was 40, a successful businesswoman and much loved by her parents and brother.
The stated goal of her oncologist was to prolong her life as her condition was incurable. However, the prognosis was 12 months.
Like most cancer patients she was immunosuppressed as the result of the exhaustive treatments including chemo and radiotherapy. She was on a regimen of antibiotics but they were temporarily suspended due to some issues with liver function which made her even more susceptible to life-threatening infection.
In March 2016 Isobel was found unresponsive in her bed and her mother called an ambulance. She was taken to a regional hospital where she was diagnosed with sepsis, and what appeared to be opioid toxicity from the pain-killing medications she was prescribed and consequent renal failure.
Appropriately, she was treated with Naloxone with good effect to reverse the effects of the painkillers with a rapid increase in respiratory rate and improved loss of consciousness. It appeared that she was on the mend. With inotropes, IV fluids and IV antibiotics, Isobel regained consciousness and was noted to be responding appropriately to questions when asked. She was saying hello to staff and had spontaneous mild work of breathing. Her oxygen sats were 95%, and she had opened her bowels and sipped tea. She had no fever, and her GCS was normal at 15. She was not in pain.
For reasons completely unknown medical staff reintroduced IV morphine despite the opioid toxicity which had largely caused Isobel’s admission. By the next morning, Isobel’s condition had declined. It was then decided to administer hydromorphone and midazolam for comfort and Isobel was moved to a single room in the ICU. By midday Isobel’s condition had deteriorated further and she was losing consciousness. Pain management continued which led ultimately to respiratory acidosis.
Isobel’s parents say that the hospital had failed to give life support to facilitate the continued antibiotic regime with the hope of prolonging Isobel’s life and had instead prescribed lethal doses of pain medication which would inevitably end her life. There were also issues with respect to the alleged discriminatory withholding of life support and resuscitation because of Isobel’s prior decisions regarding an alternative treatment for her underlying cancer through natural therapy.
The thrust of Isobel’s parent’s complaints was that the hospital had inappropriately implemented end-of-life care through the administration of opioids (Morphine) and benzodiazepines (Midazolam) without exhausting treatment options. They say that had Isobel had received appropriate treatment she would have recovered from the sepsis and come home at least for the few months she was expected to survive. Isobel was deprived of that valuable time she had left with her parents and family.
As Isobel died in circumstances where her death was not the reasonably expected outcome of a ‘health-related procedure’ carried out in relation to her, noting that a ‘health-related procedure’ includes the administration of an anaesthetic, sedative or other drug it is a reportable death under Section 6(e) of the Coroners Act 2009 (‘the Act’) and is currently the subject of a Coronial Inquest. Regrettably, the Coroner refused to hold an inquest into the matter despite very detailed submissions, having been satisfied that the hospital had implemented new policies to deal with end-of-life care.
Isobel’s family were understandably devastated and all developed psychological conditions which are lasting and severe. With our assistance proceedings were commenced in respect of their mental harm claims and later resolved to the satisfaction of her parents and siblings.
If you, or someone you know has been a victim or suffered loss because of poor medical advice please contact us today. You can click here to book an appointment or call us on (02) 4050 0330 to book a no-obligation consultation.
