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 JOAN McGLINCHEY, aged 32 years who resided at 40 Ardencraig Quadrant, Glasgow died at Victoria Infirmary at 14.05 hours on 1 May 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 had a heroin addiction problem for a number of years before her death.

(2) The deceased was admitted to the Accident and Emergency Department of Victoria Infirmary at 21.29 hours on 30 April having been conveyed there by ambulance. The ambulance crew had noted "has suffered flu symptoms recently and had a seizure tonight lasting a few minutes". She was seen by a specialist registrar in Accident and Emergency at 22.00. He noted a history that she had been unwell for two days with headaches and nausea; that she had then "blacked out" and had been incontinent of urine. She admitted to "muscle popping" recently. He observed a large area of indurated cellulitis extending across the right thigh and into the area of the groin. A clinical diagnoses of cellulitis and septicaemia was made. She was commenced on intravenous fluids with antibiotics, these being fluxloxacillin and ceftriaxone. Blood samples and cultures were arranged and a white cell count of 67 was revealed.

(3) Overnight the deceased's blood pressure fell. Early on 1 May it was noted that there was no fever but the white cell count was "massive". Necrotising fasciitis was suspected. She was described as "confused" and "talking in one word sentences". A decision was taken to operate on the area of cellulitis once she was stable. In the meantime intravenous fluids were continued and benzyl penicillin added to the antibiotics. Unfortunately, her general condition deteriorated. Despite treatment for the symptoms of septicaemic shock in both Intensive and Coronary Care Units she died at 14.00 hours on said date.

(4) Post-mortem examination revealed extensive areas of cellulitis in the area of the flank and right thigh. There were striking pleural and pericardial effusions. Microscopic examination of tissue from the flank and thigh showed appearances of necrotising fasciitis. These findings together with the clinical picture are consistent with a toxin producing organism having led to necrotising fasciitis and death from multiple organ failure.

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] This case follows the classic pattern of the rapid onset of symptoms of septicaemia and is entirely consistent with infection from a clostridium novyi type infection. There are no special features.