promises improvements made after five-week delay led to anorexia
by Staff Reporter
trust mangers promise they have improved how referrals from GPs
are handled. The pledge comes after a teenager died from anorexia
following a five-week delay between referral and assessment.
A coroner yesterday criticised the “inappropriate” delays
in the assessment and treatment of Charlotte Robinson, aged 18,
from Norfolk, which “reduced the likelihood of a recovery”.
Ms Robinson contracted a fatal bout of pneumonia last year when
she was critically malnourished.
sickness was a factor in the delay, the inquest had heard.
spokeswoman for the Norfolk and Waveney Mental Health Trust said
after the inquest: "The systems regarding GP referrals and
cover for staff absence...were improved and implemented during the
summer of 2007."
Robinson had first displayed symptoms of anorexia no later than
February 2007, Greater Norfolk Coroner William Armstrong summarised
in a narrative verdict.
said: “On April 30 she was referred by her GP to the mental
health team [at Norfolk and Waveney Mental Health Trust]. There
then followed an inappropriate delay before Charlotte was seen by
a mental health nurse on June 5.
this initial meeting, when no comprehensive assessment was undertaken,
and as a result of a failure of effective liaison there was then
a further inappropriate delay before she was seen again on July
3, by which time her condition had further deteriorated.
condition continued to deteriorate and on July 13, contrary to her
earlier expressed views, she agreed to a referral to Newmarket House,
a specialist facility for patients suffering from eating disorders.
was admitted to Newmarket House on July 20, by which time she was
in a grave condition.
July 22, she became critically ill and was transferred to the Norfolk
and Norwich University Hospital where, despite proper medical attention
she died on August 8.
inappropriate delays in the initial referral to the mental health
team and in arranging the second meeting with the mental health
nurse reduced the likelihood of a recovery from the illness.”
Armstrong said “no one individual was to blame” and
concluded it would have been inappropriate to detain Miss Robinson
under the Mental Health Act and to effectively force feed her.
Norfolk's assistant director for commissioning Mark Weston said
there were “very clear lessons” from the case.
NHS Norfolk this issue has been taken extremely seriously. It will
lead to change. My chief executive and deputy chief executive see
it as a major priority to make changes in this area and it is being
reviewed at the most senior level.”
David Bowker, retired consultant psychiatrist, Manchester
January 9, 2009
The option of GPs to refer only to a 'mental health team' is highly
undesirable. It is not clear whether that was the case here. A GP
should have the option of referring directly to a consultant psychiatrist
in the type of case described. Nothing is better than a direct conversation
with someone who will take responsiblity for following a case through.Teams
are likely to have individuals of varying expertise and experience,
and referral should be possible to that person, who in the opinion
of the GP is best able to assess the patient. However it remains
the responsibilty of the GP to pursue referrals considered urgent
if unhappy with progress.
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