Family forgives GP for 'missed opportunities' in treatment that led to fatal ulcer
THE family of a Christchurch woman who died from a stomach ulcer partly caused by her medication have forgiven the GPs that treated her.
The inquest into the death of 58-year-old April Stevenson heard that she was a patient at Christchurch Medical Centre in Purewell where she had been prescribed a drug to treat back pain.
One of the partners there, Dr Temitope Odetoyinbo, admitted “opportunities had been missed” to spot she should have been taking a second type of medication to guard against potential fatal ulcers developing.
But Mrs Stevenson’s sister, Shirley McEwan-James said the family bore no ill-will towards the doctors as the drug prescribed had given her an improved her quality of life.
“April thought you were a wonderful GP,” she told Dr Odetoyinbo. “The drug did what it should – it made her feel better.”
Mrs Stevenson, a senior travel consultant for Bath Travel who lived in Stanpit, was first diagnosed with multiple sclerosis in 1989, the inquest heard. She carried on in the job she loved until taking semi-retirement in 2004 and worked part-time for another eight years.
In early 2016 she was referred to a specialist for back pain and he recommended she take the non-steroidal anti-inflammatory Diclofenac, a suggestion adopted by a GP at Christchurch Medical Practice (CMP).
The inquest was told the drug can come with a range of side effects, including stomach ulcers. Often those on Diclofenac are also prescribed a proton pump inhibitor (PPI) – a type of medication that helps limit acid production in the stomach and keep ulcers at bay.
At the Bournemouth inquest Dr Odetoyinbo admitted CMP doctors, including herself, had consultations with Mrs Stevenson during 2017 but failed to spot she was not being given a PPI.
“That was a missed opportunity on our part for which we would sincerely like to apologise,” she said.
However, she added, it was not certain that caused the ulcer. “Would this have made a difference? I am unable to answer but I’m deeply sorry for my clinical practice in this case,” she said.
It was only in late 2017 that a nurse flagged up Mrs Stevenson should be on a PPI and even then that medication was only temporarily prescribed, the inquest heard.
On the morning of 4th October last year, the inquest was told, Mrs Stevenson became concerned about her condition and she was taken to the Royal Bournemouth Hospital.
Tests did not prompt major concerns although doctors arranged for her to have a gastroscopy the following day.
That night she was initially stable but later went into cardiac arrest. CPR was performed but she could not be saved.
Dr Odetoyinbo outlined that since the shortcomings had emerged she had authored a “risk report” which she handed to the inquest.
CMP staff were undergoing further training on medication prescription and its practices. The use of Dicolfenac had undergone a full review and patients prescribed it had been called in and had the potential side effects and risks explained to them, she said.
There had also been a “significant event meeting” about Mrs Stevenson’s case with all GPs, and another would be held after the inquest to review the situation.
In a statement, Mrs Stevenson’s husband Ian said his wife worked for Marks & Spencer and P&O before Bath Travel.
He said she had an “amazing appetite” for jewellery, fashion and travelling and the pair had not had children as they “liked their holidays too much”.
They met in the late 1970s, began a relationship in 1985 and travelled extensively. They got married in 2003 and lived in various places, including Lymington, before moving to Christchurch.
A post-mortem examination confirmed Mrs Stevenson died of an internal bleed caused by an ulcer.
Assistant Dorset coroner Richard Middleton concluded Dicolfenac was a “contributory factor” but did not directly cause the fatal ulcer.
Mr Middleton said he was “grateful” to Mrs Stevenson’s sister for indicating the family were not blaming CMP or Dr Odetoyinbo. He noted Dicolfenac “eased” the pain Mrs Stevenson was suffering with her back and improved her quality of life.
Mrs Stevenson had been made aware by Dr Odetoyinbo of the risks and side effects when she was prescribed Dicolfenac, the coroner added, but he acknowledged the GP’s admission of a “missed opportunity” in spotting the lack of a PPI.
Mr Middleton also noted Dr Odetoyinbo’s report and the work CMP had done since Mrs Stevenson’s death in highlighting shortcomings.
“I’m satisfied that the surgery has done all that can be asked of them to rectify any problem that night have existed,” the coroner stressed.
He reached a narrative conclusion that Mrs Stevenson died of a naturally occurring disease exacerbated by a recognised complication of prescription medicine.
