Scottish Sheriff Court Decisions

GLASGOW, 25 February 2002.

The Sheriff Principal, having considered all the evidence adduced, DETERMINES: in terms of the Fatal Accident and Sudden Deaths Inquiry (Scotland) Act 1976 Section 6(1) (a) that DAVID CAMERON, aged 34 years who resided at James Duncan House, 331 Bell Street, Glasgow, died at Glasgow Royal Infirmary at 07.00 hours on 7 August 2000;

(b) that the cause of death was multi-organ failure secondary to necrotising fasciitis and toxin producing organisms;

(c) that there is no evidence of any precautions which might have avoided the death of the deceased;

(d) that the death of the deceased was not caused by any defect in a system of work;

(e) that the following facts are relevant to the circumstances of death:

(1) The deceased was known to be an intravenous drug user for at least two months prior to his death. On 2 June 2000 he was admitted as an emergency to Glasgow Royal Infirmary with abscesses on both upper arms as a result of injecting into the area of muscle. Both abscesses were incised and drained and he was discharged home on 4 June.

(2) The deceased attended at the Accident and Emergency Department of Glasgow Royal Infirmary at 10.47 hours on 6 August 2000 complaining of an abscess on the right buttock. It was found to be extensively indurated, inflamed and tender and was "pointing" into the rectum. His temperature was low at 35.1 degrees centigrade. His pulse rate was elevated. He was admitted with a view to ultra-sound examination to locate pus, a Doppler scan to check for deep vein thrombosis, and the obtaining of a full blood count.

(3) An attempt was made by a junior house officer to take blood from the deceased during the evening of 6 August. This proved impossible due to the state of the deceased's peripheral veins. A further attempt to obtain blood from the pulmonary artery was made by a senior house officer in the early hours of 7 August. That attempt was again unsuccessful.

(4) Overnight the deceased was given diazepam and dihydrocodeine to relieve pain. He was also given methadone. He was noted showing signs of withdrawal symptoms, perspiring, shaking and feeling "terrible".

(5) At 06.40 hours on 7 August 2000 the deceased was found lying on the floor outside a toilet. He appeared to have sustained a cardiac arrest. All attempts to resuscitate, including cardiac massage, incubation and ventilation failed. He was pronounced dead at 07.00.

(6) Post-mortem examination revealed moderately large bilateral pleural effusions and lung congestion. There was an area of purplish discolouration over the right buttock, extending to reddening over the outer hip. At the area of maximum discolouration there was an abscess cavity 5cm deep containing green pus. Microscopic examination showed appearances consistent with cellulitis and necrotising fasciitis. No significant organisms were found at bacteriology.

NOTE:

[1] For my comments on the background to the multiplicity of deaths of injecting drug users in Glasgow during the period April to August 2000 reference is made to the General Note appended to the determination in the case of Andrea McQuilter.

[2] Despite the absence of bacteriological evidence confirming the presence of clostridum novyi infection the clinical and post-mortem findings in this case point very strongly to the presence of such infection. That being so it is likely by the time Mr Cameron arrived at hospital on 6 August his infection was at an advanced stage and death was probably inevitable.

[3] That said, this does appear to be a case where the potential severity of the symptoms was not appreciated by the junior medical staff who saw him. That was the view of an independent expert Mr McGregor who had examined the relevant records and reports, and indeed was acknowledged by Mr Stuart the consultant into whose care the deceased would have come. The records were to a certain extent inadequate, but it is clear that there was no sense of urgency about obtaining a scan (which ought to have been done on the day of admission), and the obtaining of a blood sample was left to a very junior doctor. That doctor did all that could reasonably be expected of him, but the senior colleague whom he called upon to assist might have appreciated that further steps, such as seeking assistance from an anaesthetist, should have been taken to obtain blood as a matter of priority. Perhaps more importantly, it is clear that all the relevant information relating to the "outbreak" had been made available by 6 August and it is surprising that the clinical senior house officer, who has since returned abroad, was not alive to the potential gravity of a patient presenting with a large abscess and signs of toxaemia.

[4] In these circumstances it is possible, although unlikely, that swift surgical intervention and the application of antibiotics might have avoided Mr Cameron's death. As indicated his very rapid deterioration makes this unlikely and I am not disposed to make a formal finding that his death "might" have been avoided.