CCS staff not to blame in death, doctor says

By ANGELA GREGORY

Staff at a CCS centre did nothing that could have contributed to the death by blood poisoning of a teenager with spina bifida, says an intensive care expert.

Dr David Gellar of Middlemore Hospital yesterday told an inquest into the death of Jeremy Gregory that the underlying cause of the 18-year-old's illness had been difficult to diagnose.

Jeremy died in February 2000 from septicaemia, secondary to a spreading infection called necrotising fasciitis, caused by an abscess in his rectum.

His family thought his illness was a result of what they claimed was substandard care at the Potter Masonic Children's Centre in Karaka, South Auckland, where Jeremy had been trying to live independently in a flat.

But Dr Gellar, Middlemore's clinical director of acute services, testified at the coroner's court hearing in Auckland that Jeremy's death could not be blamed on the centre staff.

"This was not a diagnosis to make in the environment in which he was being looked after. It was not made by two GPs, and not made on admission to hospital."

Dr Gellar said that while Jeremy appeared to have developed the rectal abscess over some time it was difficult to detect, and he had been no more likely to get it than anyone else.

Dr Gellar said a deep sore on Jeremy's bottom might have been the result of the spreading infection and contributed to by the pressure of his sitting in a wheelchair.

But the primary problem leading to his death was the abscess, which was not picked up, despite a digital and internal examination of his rectum, until two days after he was admitted to hospital.

Doctors had initially presumed that Jeremy's illness was caused by the gastroenteritis from which he was also suffering, and "subtle signs" of the real problem were missed on an x-ray.

Dr Gellar said a correct diagnosis had also been made more difficult as Jeremy had no sensation from the waist down, which meant any pain symptoms were absent.

But he did not think the delays in diagnosis would have significantly improved Jeremy's chances of survival.

Necrotising fasciitis was hard to treat and had a mortality rate of about 50 per cent. "It is extremely aggressive and destructive ... It destroys tissue as it goes."

Dr Gellar said because Jeremy was confined to a wheelchair and had difficulty in managing himself, his chances of surviving the illness were considerably less than for others.

Even if he had been treated sooner, Dr Gellar did not think Jeremy would have had a good outcome.

Since Jeremy's death, Middlemore Hospital had changed its procedures by referring any soft-tissue infection where possible straight to the surgical unit.

In earlier evidence the supervisor at the Potter centre, Vivienne Hohaia, said it was extremely insensitive to look at the bottom of an 18-year-old man.

"You need to understand what that means ... It is an invasion of his whole being."

Caring for the disabled required a holistic approach that was not simply focused on medical issues.

Mrs Hohaia, in tears, finished her evidence by reading a statement to the court in which she said she was appalled that skilled people at the centre had been devalued during the inquest.

She said she had lived with Jeremy in the centre for nearly four years, longer than anyone else in his life, and it had broken her heart when he died.