Elderly woman’s death prompts calls for dementia ward

Friday 31 January 2020

A senior doctor has called for a specialised ward to treat dementia patients in Jersey after the death of an 82-year-old woman at a St. Saviour mental health facility.

The comments came from Dr Petra Schinle – a Consultant in Acute Medicine at Jersey Hospital – during the first day of an inquest being held to establish the cause of death of Annick Sheehan, who had dementia, in 2018.

The inquest heard that her cause of death was initially recorded as being due to cancer, but a scan carried out afterwards showed “no radiological evidence” of this being the case.

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

Mrs Sheehan died in the early hours of 6 November 2018 whilst receiving care on Oak Ward at St. Saviour’s Hospital, and her death has shone a light on the difficulties of treating dementia patients.

Relief Coroner Dr Martin Barrett heard that Mrs Sheehan was admitted to the hospital’s Emergency Assessment Unit after her husband, who was also her full-time carer, had a fall and broke his hip in June 2018. It was intended that Mrs Sheehan would remain in hospital until her husband could care for her again.

Giving evidence, Dr Schinle said that after running some tests and carrying out an examination, she decided to transfer Mrs Sheehan to a ward at St. Saviour’s Hospital – not least because she said Jersey’s hospital wards were inappropriate for treating dementia patients.

Giving her evidence, Dr Schinle said that the emergency unit where she works “is not a safe place" for them.

"[There’s] a lot of admissions, a lot of movement, it’s a noisy environment, it’s an environment that’s not geared towards dementia," she explained.

The doctor said that these factors can be particularly distressing for those with dementia and that they are better placed in wards that have been specially designed for the condition.

This is why, Dr Schinle argued, that Jersey's hospital needs its own specialised dementia ward. 

She told the inquest: “We don’t have a dementia ward in the hospital. In the future, [that’s] definitely something we should look at. That is definitely needed for the future in every Western country.” 

Dr Schinle added that the issues facing medical staff when treating patients with complicated medical conditions as well as dementia warrant having a specialised ward at the hospital in the future.

The inquest heard Mrs Sheehan also had cancer, diabetes, as well as ongoing anaemia and kidney failure, in addition to Alzheimer’s.

Speaking generally about treating patients who have serious medical issues as well as dementia, Dr Schinle explained that this can be “very difficult” for health professionals because “the patient has multiple probabilities." 

“To have to look into every area and make sure you have a holistic approach is very, very difficult,” the Consultant remarked.

As an example, when treating someone with dementia, Dr Schinle said that she is required “to get consent for everything” she does, including running blood tests and “often dementia patients do not know why I am doing this." It therefore, “...becomes more and more difficult to do those blood tests,” she explained.

Elsewhere in the hearing, expert pathologist Professor William Roche provided independent analysis of the post-mortem examination findings of local Consultant Pathologist Dr Helen Goulding.

Having summarised all the documents relating to Mrs Sheehan’s case, Professor Roche concluded that, contrary to what was stated on her death certificate, cancer did not cause her death.

In his professional opinion, it was the levels of painkilling and sedative medication that Mrs Sheehan was taking as part of her palliative care programme that led to her deterioration in health and eventual death.

In the conclusion of his report, he stated: “Having reviewed all of the material made available to me, I can find no natural disease sufficient to explain the death of Mrs Annick Sheehan on 6 Nov 2018."

He also noted that “Mrs Sheehan was walking about the ward on 30 Oct and her subsequent rapid deterioration appears to be related to the administration of sedative and opioid medications".

"In my opinion, it is reasonable to conclude that the immediate cause of death was the administration of terminal sedation, in the form of opioid and sedative drugs, during the last week of Mrs Sheehan’s life," the report read.

The inquest also heard from Police Coroner’s Officer Tony Forder, Dr Abdul Shah, a Staff-Grade Psychiatrist from St. Saviour’s Hospital who cared for Mrs Sheehan, and Dr Glyn Thomas, a consultant in old-age psychiatry.

The inquest continues today.