Elderly woman died after refusing hospital transfer, coroner finds

 

The coroner has recommended the Tasmanian ambulance service rewrite its policies around refusal of treatment after a 75-year-old woman twice refused to be taken to hospital and two days later died.

Tasmania’s ambulance services visited Feryne Hunter twice in the two days before her death, but both times she refused to be taken to hospital.

But the coroner found that Ambulance Tasmania was not at fault. 

“I cannot speculate why Ms Hunter did not wish to accept medical treatment on the two successive days before her death, but I am satisfied that she had the ability to call for assistance when she required it,” coroner Olivia McTaggart said in her findings.

“There was nothing that could reasonably have been done by the nurses, carers, paramedics or police officers that could have prevented Mrs Hunter’s death,” she said.

“All acted appropriately and, to the extent possible, in her best interests.”

Ambulance visited twice in the days before death

Ms Hunter’s body was discovered by her nurse on the morning of 13 September 2017.

Ms Hunter was a widow who lived alone in Glenorchy, Tasmania. All her three children live interstate. Formerly a beauty therapist, she was retired at the time of her death

Ms Hunter was receiving care from district nurses three times a week for her tracheostomy.

On the morning of 11 September 11, two days before her death, Ms Hunter’s nurse noted she was “tired” and had “tracheostomy blockages”. Ms Hunter was not “as bright and chatty as usual”.

Later that day the nurse saw Ms Hunter “was having trouble breathing and was unable to talk”.

Paramedics arrived shortly after and recorded Mrs Hunter as being “alert, orientated, breathing normally, but with a slightly elevated temperature”. The nurse called the ambulance, which arrived in seven minutes.

The ambulance service’s notes state, the “patient refused hospital transport, which was voluntary, she was informed of risks associated with non-transport, the refusal was relevant to the current complaint, she had capacity to refuse and was given appropriate to discharge advice.”

Ms Hunter was told to make an appointment with her GP for the next day, however she did not see her doctor the following day.

On 12 September, the following day, Ms Hunter’s neighbour called triple-0 but due to a series of mishaps, an ambulance did not arrive until much later, at 10.13 pm that night.

Ms Hunter refused to be assessed by paramedics. “I want you all to go away and leave me alone,” she said.

The paramedics took the view that Mrs Hunter had the capacity to refuse an assessment, and left.

The coroner said, “I accept that Ms Hunter did use those words and find that she was adamant in refusing assessment, treatment or conveyance to hospital.”

She said all present were “of the view that there was no further assistance they could give.”

But the next morning her nurse could not raise her at the front door. After entering the home through the back door, the nurse tragically found Ms Hunter dead in her bed.

The State Forensic Pathologist found that Ms Hunter died as a consequence of airway obstruction due to aspiration occluding a permanent tracheostomy.

Policies regarding refusal of treatment should be rewritten

The coroner said Hobart District Nursing Service and other health practitioners provided “diligent” and “conscientious” care.

She said there was little to indicate that Ms Hunter was not of sound mind.

The coroner said Ambulance Tasmania’s Refusal of Treatment/Transport Policy is “confusing, particularly in relation to the area of consent and diminished capacity.” She recommended the policy be rewritten to provide “simple and clear guidance” on how paramedics should deal with capacity, consent and refusal of treatment.

Image: EllenaZ, iStock.

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  1. I think she made an informed decision that she didn’t want to die in hospital. Maybe a follow up clinician visit or even palliative care may have helped her pass with minimal distress.

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