Medical misadventure verdict on pensioner’s death

A CORONER has supported the medical decisions taken by doctors after a Chichester woman died following surgery to insert a feeding tube.

Betty Garnham, 87, of Chichester, was admitted to Bognor War Memorial Hospital in November last year, when her appetite started to decrease.

As she became severely emaciated, doctors decided to carry out an operation to insert a feeding tube directly into her stomach.

She underwent surgery at St Richard’s Hospital in Chichester, before being transferred back to Bognor where her condition quickly worsened and she died shortly afterwards.

A post-mortem revealed a large amount of ‘gastric contents’ had leaked out of her stomach from around the site where the feeding tube had entered it, resulting in peritonitis. It also indicated there was laxity in her stomach muscles, which could have prevented the stomach from gripping the feeding tube strongly.

But doctors initially thought pneumonia was the cause of her post-surgery complications.

Assistant deputy coroner Karen Henderson questioned Dr Roy Holman, consultant physician at St Richards Hospital, who carried out the operation.

She asked whether a diagnosis of peritonitis could have been made earlier by a junior doctor who examined Mrs Garnham.

He said: “If they didn’t know the patient, you would have expected them to phone for help. There perhaps should have been a diagnosis of peritonitis.”

The inquest heard doctors consulted in depth with each other, Mrs Garnham and her family, as to whether or not to insert the feeding tube.

Dr Holman said there had been agreement from all parties. He added: “The procedure was very straightforward, so I was very surprised that we have had an untoward event afterwards.”

The reasons for the leakage remains unclear, but Dr Holman said one explanation could be Mrs Garnham’s low BMI causing a ‘weakening of tissues’.

Following an eventual diagnosis of peritonitis, doctors faced another difficult decision. Mrs Garnham needed surgery, but she had signed a ‘do not resuscitate’ form, barring any invasive operations.

She was therefore given antibiotics. Mr Holman said Mrs Garnham ‘would not have survived’ an operation and, in respect of her wishes, operating ‘would not have been right’.

Recording a verdict of medical misadventure, the coroner said: “The process in which the decision to insert a PEG tube was made was entirely appropriate.

“It is a straightforward procedure that Mr Holman has done many times before and was entirely reasonable.

“Following the diagnosis, the decision was made to keep her comfortable and she died shortly afterwards.”