Nelsons has represented the family at an inquest before HM Coroner for Coventry (Mr David Sarginson) following the death of Mrs Winifred Dalton from septicaemia caused by clostridium difficile (C-diff) infection, in which a jury returned a verdict of natural causes in the presence of neglect under the care of two Coventry hospitals.
Claims of neglect while the Coventry woman, aged 69, was at the Caludon Centre and former Walsgrave Hospital, centred on whether tests for C-diff should have been taken sooner and whether the delay led to her death.
Mrs Dalton had been admitted to the former Walsgrave Hospital in Coventry in November 2005 and was sent home from hospital on 26th November without any clear diagnosis of her illness. She was then re-admitted from home to a different ward. During this admission in hospital, which the consultant in charge of her care described as largely a “social” admission, her family became aware that she was suffering badly from diarrhoea.
The family was given a bag of badly soiled laundry to take home, which the family discovered contained clothing soaked in half a litre of diarrhoea. Following this, the family had telephoned the hospital to complain and ask that they provide hospital underwear and pyjamas to Mrs Dalton, since she was still suffering from diarrhoea. Notwithstanding this and despite the family themselves being present when Mrs Dalton continued to suffer diarrhoea, the nursing notes did not contain any observations that Mrs Dalton was suffering from diarrhoea. In fact, as the jury found, this omission was significant.
Before going into hospital, and well into her admission, Mrs Dalton had been receiving two “broad spectrum” antibiotics, cephalexin and co-amoxiclav (“augmentin”). She had had the cephalexin between 9th November and 23rd November and the augmentin from 20th November until 5th December. The prescription of such broad-spectrum antibiotics (especially augmentin) and also Mrs Dalton’s age, made her particularly susceptible to infection with C-diff, the principal physical symptom of which is diarrhoea. The presence of C-diff can be detected by a simple laboratory test of a stool sample, which ought normally to take between 24- 48 hours to come through, but Mrs Dalton was not tested until much later.
Mrs Dalton had also been given omeprazole (to deal with vomiting) and lactulose (a treatment for constipation) between 28th November and 5th December. On 9th December 2005, Mrs Dalton was transferred to a psychiatric hospital, the Caludon Centre. The family said that her diarrhoea had continued there, confirmed by entries in nursing notes and in notes taken by her doctor. On 12th December, a stool sample was taken and sent to the laboratory where it was tested. Results were obtained on 14th December showing that her diarrhoea was positive for C-diff. However, that lab result was placed on a computer system to which the nurses did not have access, the doctor who had ordered the sample was away for five days and the piece of paper recording the result was not taken to the ward but put in a correspondence file. Accordingly, it was not until 19th December 2005 that Mrs Dalton started receiving treatment with metranidazole, which is the principal treatment for tackling the C-diff infection.
On 21st December, Mrs Dalton’s husband who had attended on the ward and found his wife lying in her own faeces, with no nursing staff available and his wife telling him that she had not had her medication, was also called at the inquest. Mr Dalton had eventually found a doctor, who had made a complaint about the lack of nurses and the medication not having been recorded on the prescription chart. Extra nursing cover had then been sent to the ward.
On the morning of 22nd December 2005, Mrs Dalton had suffered a fall and the doctor in the Caludon Centre was sufficiently concerned that her physical condition was such that she be transferred to the Walsgrave Hospital. The doctor there had disagreed and had refused to take a transfer at that point, pending further investigation. Part of that further investigation was the taking of a blood sample, which got left in the wrong box in the pathology laboratory (although, as it happened, this omission was not causally relevant to death). Later that day, Mrs Dalton’s condition had deteriorated such that she was sent by ambulance to the Walsgrave Hospital, was admitted but with poor prognosis and she died of septicaemia caused by clostridium difficile infection on 23rd December 2005.
Evidence given to the inquest was that none of the nursing staff at the Caludon Centre had heard of C-diff and that when given the name of the condition, had to download information about it from the hospital computer. The coroner called an expert in C-diff, Professor Wilcox, who had been instructed by one of the hospital trusts involved. The family had, for various reasons, not invited the coroner to call other expert evidence. Professor Wilcox was of the opinion that the c-difficile infection was hospital acquired and had based his opinions as to when on the nursing observations of diarrhoea. He expressed the opinion that starting treatment from 14th December had not made a difference to the outcome and maintained this view even when pressed about possibly earlier dates of infection. Professor Wilcox did however state that this was the matter upon which he was least confident.
The coroner directed the jury on verdicts of natural causes and also to consider whether neglect had been present in a causal sense.
