Appendix 2: Detailed patient case studies
Case Study – Ethel Thurston
Summary of hospital admission
- In 1999, Ethel Thurston was aged 78 and was resident in a nursing home.
- On 15 June, she fell and fractured her left neck of femur. She was admitted to the Royal Hospital Haslar (‘Haslar Hospital’), where she underwent a left cemented hemiarthroplasty (partial hip replacement).
- On 29 June, she was admitted to Gosport War Memorial Hospital for rehabilitation and mobilisation.
- On 16 July, she was noted to be much more settled.
- On 25 July, she vomited but was said to be a “little brighter”.
- On 26 July, Miss Thurston died.
Background, care and treatment
In 1999, Miss Thurston was living in a nursing home. She had learning difficulties and was thought to have the mental capacity of a ten year old. Miss Thurston had once held down a job in a bank, was able to perform simple tasks and had been able to travel across London independently. She was long-sighted and wore glasses. Miss Thurston was said to have become aggressive from January 1999. In June, the nursing home had considered seeking a referral to a psychiatrist specialising in old age because of her aggression.
On 15 June, Miss Thurston fell in the dining room of the nursing home and was admitted to Haslar Hospital where she underwent a left cemented hemiarthroplasty (partial hip replacement).
On 24 June, Dr Richard Ian Reid assessed Miss Thurston at Haslar Hospital. He noted that her behaviour had:
“… been difficult in that when asked to do things she was not keen to attempt to do, she is uncooperative and has been striking out at members of staff. She has been reluctant to eat and drink and has been hoisted in and out of bed or alternatively been transferred in and out of bed with the help of three nurses. I understand that she as incontinent and as a result was catheterised … when I saw her [Miss Thurston] was pleasant and cooperative. She smiled readily. I was unable to obtain any history from her as she appeared to have very limited vocabulary and/or was dysphasic. She was able to move both legs without pain and I was able to get her to attempt to stand. She was backward leaning and not taking her full weight through her legs, but she did not appear to be in any pain and my impression was that she had the physical potential to remobilise. However, whether she will do so will be very dependent on how she behaves. I think it would be appropriate to transfer to the War Memorial Hospital for a period of further assessment and hopefully remobilisation.”
On 29 June, Miss Thurston was admitted to Gosport War Memorial Hospital for rehabilitation, care and mobilisation.
At the time of her admission to Gosport War Memorial Hospital, Miss Thurston was able to wash, dress and feed herself with encouragement and some help. Although she had a limited vocabulary, she had no difficulty in communicating. In addition to her fractured femur, Miss Thurston had an ulcer on her lower left leg, was prone to constipation and had in recent years become incontinent, which had necessitated the use of a catheter at Haslar Hospital. Miss Thurston’s drug therapy was oxybutynin (for urinary incontinence) and zopiclone (a night sedative).
On 29 June, the admission nursing notes record Miss Thurston as demented with learning difficulties; in need of hoisting with “no inclination to rehabilitate”; very reluctant to take food and fluids; and “willing to feed herself only if she feels like it”. In addition, “her behaviour can be aggressive and she has been known to strike staff”.
On 1 July, a fentanyl patch (25 micrograms) was prescribed by Dr Jane Barton. The prescription sheet records that the patch was to be given every three days. A fentanyl patch was administered on 1 July and then every three days. It was again prescribed on 7 July. The last patch was applied on 25 July.