'Serious flaws' in care of pensioner
AN ELDERLY woman died in hospital after doctors failed to properly monitor her medication.
Medics at the University Hospital of North Staffordshire (UHNS) continued to give Cicely Witkowski doses of Gentamicin, despite the antibiotic building up to dangerous levels in her body.
The 75-year-old, of Churchill Avenue, Trentham, eventually suffered kidney failure and died two weeks after staff took her off the drug.
But an inquest into Mrs Witkowski's death heard that the pensioner may not have lived much longer due to her deteriorating physical condition.
On the first day of the two-day hearing at Hartshill, the court was told that Mrs Witkowski had a long history of chronic obstructive pulmonary disease (COPD) and emphysema.
She was admitted to the UHNS on March 26, 2008, suffering from a chest infection, a day after being sent home from a previous stay.
Doctors prescribed Gentamicin to tackle the bacterial infection in her lungs.
The drug can potentially cause deafness and renal failure, meaning careful monitoring is required.
Between April 2 and April 8, Mrs Witkowski received five 400mg doses of Gentamicin.
But various experts told the inquest that the treatment should have been stopped sooner, as staff should have seen the drug was building up in the patient's blood.
Once medics became aware of the situation they filed a "serious untoward incident" report, and following Mrs Witkowski's death on April 23 a police investigation was launched.
Respiratory physician Dr Ian Johnston was asked to look into the case by Staffordshire Police.
He said: "The lack of appropriate testing and continued monitoring of her renal function fell below the standard you would expect, and not in a minor way.
"It was a serious departure from standard practice."
Dr Johnston said he would expect even junior doctors to be well aware of the potential risks of prescribing Gentamicin, and their hospital's particular protocol for monitoring its use.
He added: "I don't ever recall Gentamicin not being taken seriously, with monitoring required. Certainly in my junior doctor days, monitoring was de rigeur."
Chemical pathologist Dr Stephen Morley also questioned the size of the dose given to Mrs Witkowski.
He said: "The dose should be related to the weight of the patient. I'd say 400mg was a large dose."
But the inquest also heard that even if Mrs Witkowski had not been prescribed Gentamicin, she probably would not have lived much longer.
The retired nursing home carer developed COPD after smoking for most of her life, and had been admitted to hospital several times in the months before her death.
Dr Johnston added: "I think it unlikely that she would have made it to the end of 2008."
Mrs Witkowski's daughter Sharon Hawkins told the inquest that despite her mother's illness, she did not think she was close to death.
She said: "She's been described as frail, but I don't think she was. She was quite a strong person, mentally. We'd seen her as poorly in the past and bounce back."
The inquest continues today.