Inquest: “Something positive can come out of this”

Saturday 01 February 2020

Concerns about the care of an 82-year-old woman with dementia triggered a ‘serious incident investigation’, which called for greater collaboration between mental and physical health professionals, it has emerged.

Details of the report were relayed on the second day of Annick Sheehan’s inquest, which is aiming to establish why she died while being cared for at a St. Saviour mental health facility in 2018.

Her cause of death was initially recorded as being due to her longstanding cancer, but a scan carried out later showed that this was not responsible.

Questions have since been raised over whether the levels of painkilling and sedative medication could have contributed.

Pictured: The elderly woman's death has prompted a series of recommended changes to improve dementia treatment.

Mrs Sheehan not only had dementia, but also cancer, diabetes and ongoing anaemia and kidney failure.

Palliative care specialist Dr Tim Harrison, who was called to give evidence at the inquest and also co-authored the report into Mrs Sheehan’s care, expressed his hope that “something positive can come out” of her death by improving the care provision for similar patients with a mixture of needs in the future.

The consultant asserted that “there are certainly lessons to be learned” from Mrs Sheehan’s death, including introducing guidelines for treating dementia patients and improving links between mental health and physical health specialists.

His comments followed testimony on Thursday from a senior doctor in acute medicine, who said that Jersey “definitely” needs a specialised dementia ward to best treat patients with the condition.

Staff-Grade Psychiatrist Dr Abdul Shah, who worked on the ward caring for Mrs Sheehan, also spoke on the first day of the inquest about how it is often “not an easy task” to get medical specialists based at the General Hospital to give advice on psychiatric patients in St. Saviour.

Pictured: Mrs Sheehan died whilst receiving care at St. Saviour's 'Oak Ward'.

Yesterday, Dr Harrison has echoed these calls for change.

In a report co-authored by him and the Head of Quality and Safety at Health and Community Services Tarina Le Duc and Dr Kirstie Ross, Associate Specialist Emergency Department, the following findings were made regarding Mrs Sheehan’s care:

• there was a “lack of acute medical assessment and investigations of the underlying causes of pain and distress”;
• the replacement of one type of medical tube with another was “inappropriate”;
• there was “no record of comprehensive assessment or plan to establish the cause of symptoms or progress of illness and no rationale for deciding the patient should receive end of life care”;
• there was “no evidence of a clear overarching plan from admission that sought to review a discharge plan nor set out the anticipated events of the future for the patient”;
• “all services involved in the patient’s care never sat down together to review their collective plan”;
• there was a “lack of a uniform and comprehensive approach to the management of delirium across health care services”;
• and there was a “lack of policy and procedures identifying criteria for admission, discharge and transfer within the older adult mental health services”.

Suggesting a reason for these problems, the report pointed to a lack of “multi-professional decision-making regarding Mrs [Annick Sheehan’s] prognosis or change in goals of treatment as she became less well”, adding that there is a “lack of provision and a process for inpatients requiring ongoing concurrent physical health and mental health care”.

The report therefore recommended:

• that no patients who are receiving medication by a tube should be admitted to a mental health ward;
• any change in a patient’s needs should warrant a full team meeting with a range of professionals and the patient’s family to create a treatment plan;
• mental health in-patients who need a physical health care assessment should only be admitted to mental health units “if they are deemed medically fit for discharge”;
• developing a framework and introduce training for treating delirium;
• and creating a way of assessing pain for patients with cognitive impairment. 

Answering questions from presiding Relief Coroner Dr Martin Barrett, Dr Harrison said: “My hope would be something positive can come out of this." 

Pictured: This case has highlighted the need for more collaboration between physicians and psychiatrists.

Associate Chief Nurse Rebecca Sherrington confirmed to the inquest that all of the recommendations in the serious incident report are supported by the Health Department, and progress on each of them is being monitored by a senior panel of health professionals.

Other witnesses told the inquest that progress has been made since Mrs Sheehan’s death in 2018.

Dr Miguel Garcia, Jersey’s Associate Medical Director for Mental Health, described himself as “a champion” of a more joined-up approach.

He explained that he would like to see every patient transferred from the General Hospital to mental health ward supported by both a physician and psychiatrist.

As plans to overhaul the entirety of the St. Saviour’s campus get underway – which Dr Garcia has previously outlined in an exclusive interview with Express – he says that he feels “very positive” and “these dialogues are happening now on a weekly basis.” 

Elsewhere in the inquest, there was testimony from mental health nurses who were working on the ward when Mrs Sheehan had been admitted and Dr Mike Winspear, a GP who briefly treated the elderly woman the day before she died. 

A number of hospital records and reports detailing aspects of Mrs Sheehan’s care were also read to the inquest as evidence. 

The inquest will resume for a final day of evidence in March.