Ms H - non-inquest findings

23y · Female·Necrotising retroperitoneal fasciitis due to acute perforated gangrenous appendicitis

Ms H, a 23-year-old with Asperger's syndrome and intellectual impairment under OPG guardianship for healthcare decisions, presented to Redcliffe Hospital ED with abdominal pain, vomiting and diarrhoea. Despite clinical concerns (fever, tachycardia, elevated white cells, pyuria suggesting UTI), she self-discharged against medical advice on 1 May 2015 before imaging could exclude surgical causes. The hospital was unaware of her OPG guardianship status. She re-presented 2 May with perforated appendicitis causing necrotising retroperitoneal fasciitis and sepsis, dying 7 May 2015 despite surgical intervention. Key clinical lessons: presumption of capacity may not apply when guardianship is unknown; early consideration of acute appendicitis in presentations with fever, tachycardia, right lower quadrant pain and elevated inflammatory markers; robust senior medical review before allowing discharge against advice when diagnosis is uncertain; systemic barriers to inter-agency information sharing about guardianship orders limited escalation and safety checks.