Hospice death review in Somerset
Somerset health workers are to receive more training to help patients with limited mental capacity following the death of a woman who had been unconscious for more than a decade.
Somerset health workers are to receive more training to help patients with limited mental capacity following the death of a woman who had been unconscious for more than a decade.
Rebecca Smith, known as Becca, passed away at a Somerset hospice in October 2021, having spent the last 12 years of her life unconscious following a seizure and cardiac arrest.
The Somerset Clinical Commissioning Group (CCG), which allocates the county’s health resources, undertook a review of the decisions which led up to her death, which occurred after Becca’s family and doctors agreed to withdraw her treatment.
Health bosses have concluded that clinicians need more training to ensure patients’ mental capacity is properly accessed and the family are closely involved through the process.
Becca was the middle sister of a Somerset family, who described her as loving the outdoors and having “an adventurous spirit”.
In 2008, at the age of 34, she fell while climbing out of a window and fractured her hip.
Two weeks later, she had a seizure and went into cardiac arrest; she remained unconscious despite her father’s attempts to revive her through CPR.
Becca was diagnosed by neurological experts as having a hypoxic brain injury (injuries caused by the flow of oxygen to the brain being restricted) and was in “a minimally conscious state” (where she had little awareness of her surroundings).
She was later diagnosed as having a prolonged disorder of consciousness (PDOC), and was admitted into a Yeovil care home in 2009.
Becca remained unconscious throughout her time at the care home, meaning she could not communicate at all with health professionals or her family.
A feeding tube was inserted directly into her stomach to provide her with food, water and medication, and she received both botox and physiotherapy to “help manage contractures to her limbs”. During this time, she also developed diabetes.
Her needs were reviewed on an annual basis by the neurology department at Musgrove Park Hospital, which is operated by the Somerset NHS Foundation Trust.
From February 2019, Becca was frequently admitted to A&E, first for pnuemonia and later for sepsis – leading to discussions with Becca’s family in the summer of 2020 as to whether continuing treatment was in her best interests.
Yeovil Hospital’s ethics committee formally approved a decision to withdraw treatment in May 2021, and Becca died “in a planned and peaceful way” at St Margaret’s Hospice in October 2021, aged 47.
The CCG subsequently undertook a review of the decisions leading up to Becca’s death, with the conclusions being published ahead of a meeting of its governing body on Thursday morning (March 31).
Emma Savage, the CCG’s deputy director of quality and nursing, said: “Becca’s family felt that they lost her at the time she had her cardiac arrest, some 12 years previously, and had not been able to mourn. They believed Becca was leading a life she wouldn’t have wanted.
“There were differing views within the family, with her father convinced she would get better, making a ‘best interest’ discussion difficult to have.
“The family reflected that the decision for Becca’s life to end was one that had been made collectively by the family and professionals involved. It was important to know and it was appreciated that Becca’s mother didn’t carry the sole responsibility for the decision that was made.”
In light of Becca’s case, and recent changes in the law surrounding clinically-assisted nutrition and hydration (CANH), the CCG has made a number of recommendations for how to improve care for patients lacking mental capacity.
Ms Savage elaborated: “This is not about changing our approach to people diagnosed with PDOC – we need to change our approach to anyone who lacks mental capacity to consent to treatment.
“Becca’s family wished that they had been invited to more meetings and reviews so they understood and stayed involved.
“We need a better understanding of the meaning of next of kin, and clinicians need Mental Capacity Act training at the right level to undertake their roles.”
In light of Becca’s fate, the CCG will be reviewing all its continuing health care (CHC) assessments to “make sure we are asking the right questions”.
It will also introduce mandatory Mental Capacity Act training across Somerset, along with training specific to PDOC patients.
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