Coroner's Finding: Procter, Sheelagh Patricia
Deceased
Sheelagh Patricia Procter
Demographics
67y, female
Date of death
2020-02-26
Finding date
2022-12-21
Cause of death
pulmonary thromboembolus due to deep vein thrombosis
AI-generated summary
Ms Procter, a 67-year-old woman with developmental delay and longstanding mental health issues, died from pulmonary thromboembolism following hip fracture surgery. Post-operatively, she refused prophylactic anticoagulation (clexane) despite repeated discussions of the serious risks including death. Senior clinicians, including consultants and psychiatrists, assessed her as having capacity to refuse treatment. Multiple senior opinions were obtained and the risks were discussed multiple times. She was encouraged to mobilise and maintain fluid intake. The coroner found the treatment standard was good and that Ms Procter had capacity to make her treatment decisions. This case highlights the tension between respecting patient autonomy in refusal of treatment and the tragic consequences when high-risk patients decline evidence-based prevention.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Drugs involved
Clinical conditions
Contributing factors
- refusal of prophylactic anticoagulation (clexane)
- immobility - patient declined physiotherapy and elected to remain in bed
- post-surgical state following hip hemiarthroplasty
- patient's fixed beliefs about medications preventing acceptance of treatment
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