Finding into death of Geoffrey Power

54y · Male·Complications of cervical spinal stenosis treated with cervical laminectomy and fusion in a man with perinatal hypoxic/ischaemic brain injury

Geoffrey Power, aged 54, with severe intellectual disability, blindness, and perinatal hypoxic-ischemic brain injury, underwent indicated cervical laminectomy and fusion for cervical stenosis. Post-operatively, he self-removed a drainage tube, then developed a wound infection despite antibiotic treatment. Following repeated hospital readmissions, he developed pneumonia with lung collapse and died from complications of the surgery. Expert review concluded the surgery was appropriate, the self-removal of the drain had no clinical impact, wound infection management was satisfactory, and the death was not preventable. Communication gaps with the family were identified as an opportunity for improvement, particularly regarding clarity on post-operative care expectations and family involvement.