A hospital patient died after electric shock therapy triggered an epileptic fit which caused irreparable brain damage, an inquest has heard.
Elsie Tindle’s brain was completely starved of oxygen during the prolonged fit last year, a jury at Sunderland Coroner’s Court was told.
There are things we know about electroconvulsive therapy, but there are things we can’t explainDr Eugene van Rheede van Oudtshoorn, psychiatrist
The hearing, before Sunderland Senior Coroner Derek Winter, heard how the 71-year-old suffered from depression and a learning disability.
Miss Tindle, who lead an isolated existence with her sister Joan, and never left their bungalow in Ryhope, was admitted to Sunderland Royal Hospital after a fall in November 2014, the inquest heard.
But the hospital was unable to manage Miss Tindle’s mental health problems. She was missing her sister, refused to take medication or food and would rip out her intravenous line.
She was considered a danger to herself and was detained under Section 3 of the Mental Health Act, which allows for up to six months’ hospital treatment.
As a last resort, medics decided to try electroconvulsive therapy (ECT), which puts electric pulses through the brain, under general anaesthetic with muscle relaxant medication to minimise the risk of broken bones.
The inquest heard that, in order to perform ECT on a patient lacking capacity to consent to it, a second opinion appointed doctor (SOAD) provided by the Care Quality Commission (CQC) must approve it.
An application for an SOAD was submitted on February 23, 2015, by psychiatrist Dr Eugene van Rheede van Oudtshoorn.
However, no SOAD had been appointed by the time Dr van Rheede referred Miss Tindle for ECT, carried out by the NHS Electroconvulsive Therapy Service at the Tranwell Unit, at Queen Elizabeth Hospital, Gateshead.
Dr van Rheede said: “She had three treatments without an SOAD in place. With Elsie we had seen a downward cycle in her health.
“We had seen her pulling tubes out. She had low potassium levels and her blood count had dropped, she was quite anaemic.
“There would have been consequences of not taking action. There was an ongoing deterioration.
“I wanted to see whether the sister would come to visit. I wanted to see if we could salvage the situation and not resort to ECT.
“We have to make a calculated decision of the benefits of taking the opportunity now, before the situation becomes difficult or impossible and that was the right time.”
The jury heard how one electrical impulse, which lasts a few milliseconds, is administered by two probes at each session and aims to initiate a 30-second seizure. Six treatments will put 40% of patients into remission, while 10 treatments work in 70% of cases.
Dr van Rheede said that exactly how ECT works is not fully understood.
“It’s used widely, but not as regularly as in the past,” he said. “There are things we know about it, but there are things we can’t explain.”
Miss Tindle had three sessions of ECT on February 27, March, 6, and March 10, returning to Sunderland Royal Hospital after each one.
Although the third session appeared to have gone as planned, Miss Tindle fell ill the following day.
She was taken to the high dependency unit, where she died 25 days later, on April 4, 2015.
“It’s a very. very rare complication,” Dr van Rheede added. “I couldn’t find other cases where someone had gone into a seizure or status epileptica a day later. However, there are anecdotal reports of people developing epilepsy after ECT, perhaps one in 80,000.”
Home Office pathologist, Dr Nigel Cooper, who performed the post mortem on Miss Tindle, concluded the formal cause of death as anoxic-ischemic brain damage, due to status epileptica, due to electroconvulsive therapy.
Miss Tindle had lived with her sister in the same bungalow in Ryhope all her life and the pair were almost completely isolated from the outside world, according to Sunderland City Council social worker Toni Cook.
Miss Cook said the pair’s late parents had kept them away from other people growing up, and that they still shared the same bed.
She described them as “very close” and said numerous efforts had been made to persuade Joan to visit her sister in hospital, mostly without success.