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Thursday, 24 April 2014

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Cumbrian mum killed by blood clot after routine knee operation

A mum died of a blood clot following a routine operation, an inquest heard.

Rachel Ann Milligan, 36, who was morbidly obese, collapsed four days after keyhole surgery on her knee in June 2010.

She died at Whitehaven’s West Cumberland Hospital not long after her husband had rushed her to CueDoc when she recognised she was suffering symptoms of thrombosis.

A post mortem revealed Mrs Milligan, of Haig Avenue, Whitehaven, died of a pulmonary embolism due to obesity and recent surgery.

Simon Ward, deputy coroner for north and west Cumbria, recorded a narrative verdict saying her death was a consequence of a recognised complication following elective surgery.

The inquest, held at Cleator Moor Market Hall, heard how Mrs Milligan had suffered from thyroid problems which had resulted in her gaining four stones. She subsequently suffered problems with her knee and had previously undergone two successful surgeries on her right knee.

However, following bad weather in 2009, Mrs Milligan had slipped, ended up in pain, limping and needing to use two crutches.

Steven Allcock, an orthopedic surgeon at the West Cumberland Hospital, told the inquest Mrs Milligan was “significantly overweight’’ and he had had “reservations about surgery due to her size’’.

However, as she was “unresponsive’’ to physiotherapy, he agreed to perform surgery on her left knee.

Mrs Milligan’s surgery was carried out on June 25 and lasted 20 minutes. Her consent form had listed the risks including pulmonary embolism.

Mr Allcock said Mrs Milligan’s knee had seen a dramatic degree of wear and tear.

“Someone who was morbidly obese had a “very much higher risk of developing complications following surgery,’’ he told the inquest.

However, after her operation, Mr Allcock said Mrs Milligan was very well and making a normal recovery.

A calf compression was placed on her leg to encourage blood flow and this was later taken off following her operation and before she was taken back to a ward to recover.

There was no evidence to state who had taken off the compression.

It was suggested by another doctor that Mrs Milligan was given a drug called Heparin, which was used to reduce clotting.

However, Mr Allcock declined to give the drug stating there was a much greater risk of bleeding.

The risk of a fatal pulmonary embolism after an operation was one in 20,000 while a risk of bleeding was one in 100.

Mr Allcock said he wouldn’t routinely give Heparin unless there had been a previous history of a deep vein thrombosis and Mrs Milligan’s previous surgeries had been successful.

He hadn’t recorded his reason for declining the drug.

The inquest heard that following her death, staff had changed their system of note taking and documentation to demonstrate evidence of consideration, Mr Allcock said.

And he added that he was “deeply sorry’’ over Mrs Milligan’s death.

Belinda Fitzwilliam, a nurse at the West Cumberland Hospital, said she had talked to Mrs Milligan after her operation and had found her very stable.

There were no concerns.

The inquest heard from Carol Tyson, who was also recovering from surgery on the same ward as Mrs Milligan.

Mrs Tyson said Mrs Milligan had told her she was suffering a lot of pain at the bottom of her leg and had been sick.

“She didn’t appear to be pulling around,’’ Mrs Tyson said.

“She was really ill and in pain. In my opinion (her death) was avoidable.’’

Graeme Milligan, Mrs Milligan’s husband, said the couple had two teenage sons.

He told the inquest that when he had come to pick Mrs Milligan up from the hospital her face was bright red.

On July 29, Mrs Milligan was becoming more distressed. She rang the ward who told her to ring CueDoc.

CueDoc told her to immediately go to the hospital. Mrs Milligan died later that evening.

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