Inquest into the Death of Petra ZELE

Inquest into the Death of Petra ZELE

Delivered on :15 January 2015

Delivered at : Perth

Finding of : Coroner Linton

Recommendations :Yes

I recommend that general practitioners advise patients to whom they are prescribing the oral contraceptive pill, whether newly prescribed or a repeat prescription, that it is a medication that should be reported when the patient is asked to complete a medical questionnaire, provide a medical history or is asked whether they are taking any medications.  This recommendation, and a copy of the finding, will be forwarded to the Western Australian office of the Royal Australian College of General Practitioners.

Orders/Rules : N/A

Suppression Order : N/A

Summary : The deceased was a fit and active young woman at the time of her death on 1 June 2010 at Fremantle Hospital. At the time of her death hospital staff certified the death having concluded that her death did not meet the requirements for a report death to the Coroner. The hospital were unaware of family concerns about her medical care.  A post mortem examination was not conducted.

In a letter to the Coroner the deceased’s mother raised concerns about her daughter’s care at the Fremantle Hospital, as well as the conduct of two other doctors in relation to the results of an echocardiogram performed on 27 May 2010, shortly before her death.

The issues which were explored at the inquest hearing were the events occurring on 9 May 2010 when the deceased presented to the Emergency Department at Fremantle Hospital and the events concerning the results of the deceased’s echocardiogram.

The Coroner concluded that as the deceased’s health progressively deteriorated she sought medical assistance on a number of occasions. Regrettably, the disease that was causing her ill health was not identified by the doctors she saw until she had collapsed and sustained an unsurvivable brain injury.

The Coroner noted the best opportunity to diagnose and effectively manage the deceased’s medical condition was when she presented to the Fremantle Hospital Emergency Department on 9 May 2010. If this had occurred the deceased would most likely have been referred to the WA Pulmonary Hypertension Program at Royal Perth Hospital and it was extremely likely the deceased would have received advanced therapies that would have saved her life at least in the short term.

The Coroner heard evidence and agreed that a recommendation should be made that more needs to be done to alert patients to the need to tell their doctor about what they might consider routine medication, in the case of the deceased, the oral contraceptive pill. A treating doctor prescribing medications need to emphasise to their patients that the medication can, in some cases, have harmful effects and it is important to tell any treating doctor that they are taking it. The Coroner made a recommendation.

Catch Words : Oral Contraceptive Pill : Echocardiogram : Natural Causes.

 

Last updated: 22-Dec-2015

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