Infection killed knee op woman from Langho

Blackburn Citizen: Agnes Goodwin Agnes Goodwin

A WOMAN who died after undergoing knee replacement surgery may have survived if medical staff had intervened earlier to treat a resulting infection, an inquest heard.

Mary Agnes Goodwin, known as Agnes, died after developing abscesses following the operation in July 2013.

Mrs Goodwin, who lived in Whalley Road, Langho, was admitted to Royal Blackburn Hospital at the beginning of this year after suffering pain in her joint and becoming ill.

Her condition deteriorated and she died on February 26, after artificial support was withdrawn.

The inquest in Blackburn yesterday heard that had the infection been discovered sooner, the outcome could have been better.

Her son, Andrew Robert Goodwin, told the inquest: “How was it missed? Senior nursing staff said ‘it’s not like she’s ill’. I think she was caught between so many different people all wanting to treat her their own way.

“Nobody would take a decision and by the time they did, it was too late.” Pathologist Dr Stephen Mills, who carried out a post mortem examination, said Mrs Goodwin had died as a result of a thigh abscess and a perirenal abscess, affecting her kidney, due to an infected knee replacement.

His examination discovered around a litre of fluid, which would have caused significant swelling and a substantial amount of pain.

The inquest heard the normal preferred treatment for an abscess would be to prescribe antibiotics and drain the fluid.

The hearing was told this did not happen and it may have been because doctors thought it would have affected a suspected deep vein thrombosis.

Dr Mills said: “It (the abscess) would be unlikely to resolve itself or be cured without any drainage of the puss.”

Michael Singleton, coroner for Blackburn, Hyndburn and the Ribble Valley, reached a narrative conclusion and said: “One of the potential risks is the development of an infection.

“It does however seem to me....that in fact an opportunity was lost in dealing with that at an earlier stage.”

Offering his condolences to Mrs Goodwin’s family, he said: “This might not have necessarily been the case and there may have been another, better outcome.”

A spokeswoman from East Lancashire Hospitals NHS Trust said: “The trust can confirm that Mary Agnes Goodwin attended the Royal Blackburn Hospital between January 31 and February 26, 2014.

“It is not our policy to comment on individual cases but we would like to offer our sincere condolences to her family and friends at her passing.

“It is trust policy to review all deaths in the hospital, and once we have received the coroner’s narrative verdict, we will contact the patient’s family and invite them to speak to us about the treatment she received.”

Comments (5)

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11:06am Thu 10 Apr 14

woolywords says...

Oh dear, not another missed opportunity, gone begging, for the want of normal clinical care found at St Elsewhere. Am beginning to sense a pattern here.
Note that the hospital spokesperson is not going to comment but speak to the family, AFTER they have read the narrative from the Coroner. Yet, they are supposed to have had a case review conference on the case.

Hands up, those whom would have thought of taking her temperature, to see if it was elevated, assuming that she probably isn't, an ovulating woman?

Hands up, those whom would have inspected the wound site, for colour changes, not associated with the healing process itself, and may have checked the condition, using the back of their hand, to sense any heat that often occurs, when there is an infection? (You can use this trick, to tell whether a child has an abscess or just normal toothache.)

Hands up, those whom would want to do a blood test, to see if there was an elevated white cell count, an indicator of sepsis, somewhere?

Hands up, those who would want to be treated, elsewhere?
Oh dear, not another missed opportunity, gone begging, for the want of normal clinical care found at St Elsewhere. Am beginning to sense a pattern here. Note that the hospital spokesperson is not going to comment but speak to the family, AFTER they have read the narrative from the Coroner. Yet, they are supposed to have had a case review conference on the case. Hands up, those whom would have thought of taking her temperature, to see if it was elevated, assuming that she probably isn't, an ovulating woman? Hands up, those whom would have inspected the wound site, for colour changes, not associated with the healing process itself, and may have checked the condition, using the back of their hand, to sense any heat that often occurs, when there is an infection? (You can use this trick, to tell whether a child has an abscess or just normal toothache.) Hands up, those whom would want to do a blood test, to see if there was an elevated white cell count, an indicator of sepsis, somewhere? Hands up, those who would want to be treated, elsewhere? woolywords
  • Score: 34

12:03pm Thu 10 Apr 14

hugofakenham says...

woolywords wrote:
Oh dear, not another missed opportunity, gone begging, for the want of normal clinical care found at St Elsewhere. Am beginning to sense a pattern here.
Note that the hospital spokesperson is not going to comment but speak to the family, AFTER they have read the narrative from the Coroner. Yet, they are supposed to have had a case review conference on the case.

Hands up, those whom would have thought of taking her temperature, to see if it was elevated, assuming that she probably isn't, an ovulating woman?

Hands up, those whom would have inspected the wound site, for colour changes, not associated with the healing process itself, and may have checked the condition, using the back of their hand, to sense any heat that often occurs, when there is an infection? (You can use this trick, to tell whether a child has an abscess or just normal toothache.)

Hands up, those whom would want to do a blood test, to see if there was an elevated white cell count, an indicator of sepsis, somewhere?

Hands up, those who would want to be treated, elsewhere?
whom am I to comment ?
[quote][p][bold]woolywords[/bold] wrote: Oh dear, not another missed opportunity, gone begging, for the want of normal clinical care found at St Elsewhere. Am beginning to sense a pattern here. Note that the hospital spokesperson is not going to comment but speak to the family, AFTER they have read the narrative from the Coroner. Yet, they are supposed to have had a case review conference on the case. Hands up, those whom would have thought of taking her temperature, to see if it was elevated, assuming that she probably isn't, an ovulating woman? Hands up, those whom would have inspected the wound site, for colour changes, not associated with the healing process itself, and may have checked the condition, using the back of their hand, to sense any heat that often occurs, when there is an infection? (You can use this trick, to tell whether a child has an abscess or just normal toothache.) Hands up, those whom would want to do a blood test, to see if there was an elevated white cell count, an indicator of sepsis, somewhere? Hands up, those who would want to be treated, elsewhere?[/p][/quote]whom am I to comment ? hugofakenham
  • Score: 4

12:39pm Thu 10 Apr 14

trajan says...

Basic nursing basic care cant even say lessons will be learned this lesson has been known since the discovery of penicillin.
Basic nursing basic care cant even say lessons will be learned this lesson has been known since the discovery of penicillin. trajan
  • Score: 15

4:24pm Thu 10 Apr 14

mavrick says...

Sadly this is why the RBH has such a bad reputation, Better qualifed and experienced doctors and nurses would have spotted this a mile away. All the medical staff involved should have their competence re tested. Is it a case of senior management being overzealous in their instruction to the point of micromanaging staff. It sounds like this poor woman was missed due to nobody taking overall responsibility. Somebody should take a holistic view of a patient and check everything has been covered. I am afraid I would not be a patient in the RBH anytime soon.
Sadly this is why the RBH has such a bad reputation, Better qualifed and experienced doctors and nurses would have spotted this a mile away. All the medical staff involved should have their competence re tested. Is it a case of senior management being overzealous in their instruction to the point of micromanaging staff. It sounds like this poor woman was missed due to nobody taking overall responsibility. Somebody should take a holistic view of a patient and check everything has been covered. I am afraid I would not be a patient in the RBH anytime soon. mavrick
  • Score: 9

5:02pm Thu 10 Apr 14

noddy57 says...

Yet another example of the failing health care system in this country,,the fact is its overloaded and the patients clearly do not get the care they once did,
Yet another example of the failing health care system in this country,,the fact is its overloaded and the patients clearly do not get the care they once did, noddy57
  • Score: 6

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