A man died after a build up of side effects from a drug he was taking to treat his paranoid schizophrenia led to his organs failing, an inquest heard.
John Warren had battled mental health problems since his early 20s. He was diagnosed with paranoid schizophrenia in 1988, a jury at Manchester coroners court heard.
He was moved to the Priory psychiatric hospital at Cheadle Royal hospital in 2000, where he had been ever since.
Tragically, though, side-effects from a drug – clozapine – caused internal problems and, after he was not able to have surgery at Wythenshawe Hospital, he died a few days later.
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Concerns over John’s care leading up to his death at the Priory and Wythenshawe hospital have been raised by assistant coroner Ms Angharad Davies, which the jury will make a conclusion of. His treatment of him with clozapine and its side effects as well as John not having the surgical procedure were also raised.
John used drug ‘of last resort’
The inquest heard John had been prescribed the drug clozapine for his paranoid schizophrenia, described as being a drug used in the ‘last resort’ when other medication doesn’t have the required effect.
He is said to have managed his mental health ‘reasonably well’ at the Priory, where he was monitored on a daily basis.
Dr Sheetal Rajashankar, a consultant psychiatrist at the Priory, described to the jury that Clozapine has a number of side effects, including causing constipation.
“It’s a very effective drug but does come with side effects,” Dr Rajashankar said.
John had a number of physical health problems in his time at the Priory, including testicular cancer and pneumonia, as well as known side effects from clozapine.
The jury was told that John was taken to A&E on Novermber 26, 2020, at Wythenshawe hospital after passing ‘dark colored stools’. A doctor in A&E referred him for a gastroscopy to check for gastrointestinal bleeding on December 17 and told the Priory if he were to become ill again to take him straight to A&E.
He was taken to A&E again on December 2, but discharged soon after. On December 16, Dr Rajashakar took annual leave, to return on December 30.
In the meantime, John attended Wythenshawe hospital for the gastroscopy procedure on December 17, however, the doctor decided that he [John] did not understand the procedure enough, and therefore could not consent to it. The procedure did not take place and he returned to the Priory.
Dr Geeta Prasad, a consultant Gastroenterologist at Wythenshawe hospital, made this decision, telling the jury she felt John was “unable to consent to the procedure”. Dr Prasad also didn’t believe the surgery was an emergency but wrote an ‘urgent letter’ to the Priory to discuss if the procedure was still in his ‘best interest’ and could be done if he did not have the capability to consent himself.
A reply did not come from this letter, however.
On December 29, John attended A&E again after falling unwell. He has displayed similar symptoms to previous A&E visits, such as dark and loose stools, with scans showing faecal impaction, which was having a severe effect on his respiratory system.
John was a long-term smoker who suffered from COPD, with the pressure on his respiratory system causing his health to quickly deteriorate. At 11am on December 30 he was pronounced dead.
His cause of death was recorded as acute respiratory failure, COPD and, intestinal obstruction due to clozapine induced constipation.
The two day inquest is being held with a jury as John died while under Section 3 of the Mental Health Act. The inquest continues.
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George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.