septic shock complicating osteomyelitis secondary to cellulitis in a woman with cerebral palsy
AI-generated summary
Sarah Hammoud, aged 22 with cerebral palsy and intellectual disability, died from septic shock complicating osteomyelitis secondary to cellulitis. She resided in a supported residential service and had recurrent elbow infections from late 2015 onwards. After initial treatment for suspected osteomyelitis in March 2016, she was discharged on antibiotics but re-admitted five days later with a tongue laceration and septic shock. An Advanced Care Plan was signed supporting comfort-focused care, and palliation was initiated. The coroner found care provided by Annecto, DHHS, the general practice, and hospital was reasonable and appropriate in the circumstances. Key clinical lessons include the challenges of managing acute illness in patients with severe intellectual disabilities without accessible substitute decision-makers, and the importance of having documented goals of care, medical powers of attorney, and communication plans in place before acute crises occur.
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Specialties
general practiceorthopaedic surgerypalliative careinfectious diseasesneurologyoral and maxillofacial surgery
severe malnutrition and immunosuppression due to low body weight (29 kg, BMI 13)
osteomyelitis from recurrent skin infections related to mobility limitations and self-harm behaviours
tongue laceration of unknown mechanism leading to secondary infection
inability to tolerate invasive investigations or surgery due to poor health status and general anaesthetic risk
communication difficulties and absence of accessible medical decision-maker during acute admission
Coroner's recommendations
SRS facilities should be required to have documents such as medical powers of attorney, financial powers of attorney and goals of care forms recorded in clients' files, with annual updates to reflect changing goals of care
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