FAMILY IN SHOCK AS BELOVED MOTHER BLEEDS TO DEATH IN HOSPITAL
No clarity over chemo treatment gone wrong
Asuper-dose of chemo was supposed to buy more time for Whanganui woman Carmen Walker. The malignant melanoma in the right ankle of the otherwise fit and healthy 77-year-old had returned with tentacles reaching up her leg.
The prognosis was grim but the cheerful, outgoing woman, once recognised as one of the most positive people in Whanganui, kept a smile on her face and continued delivering meals-on-wheels as she had done for the past 25 years.
Amputation was suggested for the former competitive swimmer, but removing the limb would only delay the inevitable. Instead, in a bid to improve the quality of life for her remaining years, Walker decided to undergo treatment called isolated limb infusion (ILI) at Waikato Hospital.
The palliative treatment is uncommon in New Zealand and not without risk, like any complex procedure.
Everyone thought Walker would emerge unscathed smiling a few hours later.
Instead, she bled to death.
“It was unbelievable to be perfectly honest,” her son Craig Walker says. “We were in absolute shock.”
The circumstances of her death in August 2010 raised many questions for the Walker family.
Eight years later, Craig and wife Linda are still grappling with the answers.
No one disputes Walker died from massive blood loss. But the shortcomings in her care mean there is no way of establishing exactly what caused the fatal bleeding.
An investigation by the Health and Disability Commission found aspects of the care given to Carmen Walker were “suboptimal” and the Waikato District Health Board was criticised for lacking several safeguards.
But the Health and Disability Commissioner took no further action against Waikato DHB or the surgeon in charge, Dr Stuart McNicoll, as the DHB no longer performs the complex procedure.
In ILI, doctors cut off the circulation to a limb with two tourniquets and infuse highly concentrated chemotherapy agents to “bathe” the cancerous cells directly in the affected limb.
At the end of the treatment, the limb’s tainted blood is drained into a waste bucket and the limb “washed out” before the tourniquets are released.
It was at this point Walker’s blood pressure dropped and her heart stopped. Despite resuscitation efforts lasting nearly two hours, she died in Waikato Hospital later that night.
Coroner Gordon Matenga ruled the cause of death was “cardiogenic shock” — extreme low blood pressure — as a direct result of the procedure.
However, the Coroner and an internal Waikato DHB investigation did not reach a definitive conclusion as to why Walker had such severe loss of blood pressure.
Several contributing factors were raised including the possibility the tourniquets had not completely isolated Walker’s leg, as her arteries were hardened from calcification. This would mean blood from her body seeped under the tourniquet, into her leg, then drained into the waste bucket during the “washout phase”.
Dr Adam Greenbaum, who observed the procedure and attempted to resuscitate Walker, was concerned at not being interviewed as part of the internal DHB investigation. He laid a complaint with Health and Disability Commissioner Anthony Hill about the care given. He believed her death was avoidable.
In a letter to Hill about the complaint, DHB chief executive Craig Climo described Greenbaum as “vexatious” after an employment dispute settled out of court.
However, Associate Professor Susan Neuhaus, the independent expert engaged by the HDC, found a number of problems, saying the DHB protocols were “conflicting and confusing”, and the team were not specialists. In her opinion, Walker most likely died from undetected blood loss during the “washout” phase.
This was disputed by the surgeon, Dr McNicoll. He believed it was more likely there was undetected internal bleeding.
Hill said he was unable to determine the cause of the blood loss, but aspects of Walker’s care were “suboptimal” and failings included the lack of measures to check for tourniquet leakage and blood outflow, he wrote in his 2013 findings.
Hill was critical of the fact the Waikato DHB did not have a dedicated team for ILI and it was the surgeon’s responsibility to ensure the team was adequately trained.
The Waikato DHB and Dr McNicoll were asked to write letters of apology to the Walker family.
In a statement, the Waikato DHB said: “It is regrettable that on this occasion, eight years ago, we did not live up to our own expectations and we continue to express our apologies to the family.”
That Hill took no further action continues to frustrate the Walker family.
“It’s hard to believe someone could die in circumstances like this and nothing happens,” said her son.
“It just feels like mum’s death was swept under the carpet.”
Craig Walker recalls driving his mother to see Dr McNicoll in his Hamilton office in June 2010. “We thought losing her leg was the worst-case scenario,” he said.
Two months later at Waikato Hospital, “we said goodbye in the ward and mum said ‘I’ll see you afterwards’,” he said. “We waited and waited and waited”.