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 CATHERINE ROZANSKI, aged 26 years who resided at Flat G/R, 16 Parnie Street, Glasgow, died at Glasgow Royal Infirmary at 20.20 hours on 11 May 2000;

(b) that the cause of death was Staphyloccus Aureus and Streptococcal Group A Toxaemia due to chronic injecting drug abuse;

(c) that the death of the deceased might have been avoided had she sought medical treatment prior to 11 May 2000;

(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 been a drug user for many years. In particular she was in the habit of injecting heroin and was known to do so by injection into the muscle, almost certainly due to the destruction of veins by repeated injections. Immediately prior to 10 May was injecting £30 to £40 worth of heroin daily.

(2) On 10 May 2000 she was seen by her sister between 1200 and 1300 hours at a street market. Her appearance was unusual. She was a pallid grey colour, was sweating and appeared to have lost weight. She was disorientated. She had bandages on her arm. Her sister asked her if she wanted to go hospital but she declined. She told her sister that she was "rattling", from which her sister inferred that she was suffering from withdrawal symptoms. Her sister offered her money to buy drugs but she refused that offer.

(3) The deceased was taken to Glasgow Royal Infirmary by ambulance on 11 May as a result of a 999 call. Her arrival was timed at 19.54 hours. The ambulance crew had alerted the hospital to her arrival and she was seen by a member of medical staff within minutes. It had already been noted by the ambulance crew and the triage nurse that she was cyanosed and unresponsive and whilst continuing to make respiratory effort was in extreme distress. (4) Shortly after arrival in hospital she proceeded to full cardiac arrest. Despite efforts at resuscitation she died shortly thereafter. The medical staff noted multiple abscesses particularly in the region of the right groin. Blood samples revealed a white cell count of 152 (indicative of extreme infection, dehydration, renal failure and muscle breakdown).

(5) The condition of the deceased on arrival at hospital was such by that stage nothing could be done to save her life.

(6) Post-mortem examination revealed evidence of chronic drug injecting into skin and/or muscle with associated ulcers and erythema of the right arm. The general findings and clinical history were consistent with multiple organ failure. Cultures from tissues taken from the right forearm and hand grew Staphyloccus and Streptococcus A both of which are toxin producing organisms.

(7) Staphyloccus and Streptococcus A are common bacteria which, whilst capable of causing infections which can produce deadly toxins, are usually susceptible to treatment by appropriate antibiotics.

(1) For my general 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] The death of this deceased was very sudden. Although clearly far from well she was out and about on 10 May. On the evening of 11 May she was rushed to hospital but was already in a coma. She received prompt treatment but died without gaining consciousness. Death was subsequently certified as being due to multiple organ failure.

[3] It is clear that the deceased must have been unwell for some time before the evening of 11 May. A tentative medical opinion was that she must have been quite unwell for about three days. There was no clear evidence that she had a particular aversion to attending hospital, although her sister said that in the past she had complained of being kept waiting and not being offered methadone. The sister also confirmed that the deceased had not been straightforward in her dealings with her GP and had concealed the fact that she was injecting at a time when she was being prescribed Valium. It is not unreasonable to assume that she felt a degree of awkwardness in dealing with medical authorities and this, together with a conviction that she was suffering from symptoms of withdrawal, may have resulted in her failure to seek advice before her collapse.

[4] The post-mortem microbiological findings of the presence of Staphyloccus and Streptococcus A and an absence of necrotising fasciitis and clostridum infection make this case (along with one other) exceptional to the others with which the inquiry has been concerned. The deceased, who was probably in a poor state of health, succumbed to a common type of infection. That infection in the normal case is susceptible to treatment by antibiotics. In that situation it appears appropriate to make a finding that had the deceased attended for treatment earlier there were prospects of her life being saved.