Woman who died at mother’s Necton home ‘struggled’ to cope after having leg amputated
A woman who died two weeks after returning home from a rehabilitation hospital struggled to come to terms with losing part of her limb, an inquest has heard.
Amanda Ironmonger, 47, died at her mother’s Necton home on November 3, 2022, Norfolk Coroner’s Court was told on Wednesday, months after having her right leg amputated below the knee.
The inquest heard that Amanda had multiple medical issues, including type 1 diabetes, asthma, and chronic obstructive pulmonary disease (COPD).
Her mother Pamela Griffin said, in a statement read to the court: “My daughter’s life was beset with medical and emotional distress.”
She said her daughter was “very poorly and hospitalised” for the majority of her life, and described how Amanda was at high risk of sepsis.
Mrs Griffin also told of how her daughter had digestive issues which led her to needing an operation to fit a stoma bag.
And the inquest heard that, after a fall at a football match in which she broke her ankle and an operation failed to fix it, Amanda required a below-the-knee amputation on her right leg, which was carried out at the Norfolk and Norwich University Hospital in June 2022.
Amanda was subsequently transferred to Pine Cottage, Colman Hospital – an amputee rehabilitation service in Norwich – on July 7.
“Her general health continued to deteriorate after that,” her mother said.
The inquest also heard from multiple health officials, most of whom described how Amanda was struggling with the loss of her limb.
Kim Picton, a mental health liaison nurse with Norfolk and Suffolk NHS Foundation Trust, said she reported feeling suicidal at this point.
“She told me she would contemplate suicide if she could not walk in the future,” she said, in a statement read to the court.
“She described herself as having a tragic life.”
The nurse added that “Amanda said she felt at rock bottom”, but wanted rehabilitation.
And Dr Moheb Gaid, consultant in rehabilitation medicine for Norfolk Community Health and Care NHS Trust at Pine Cottage, said the length of Amanda’s stay far surpassed that of most patients – with the average being under four weeks.
Her rehabilitation was hindered as she developed a blister on her left foot and she contracted sepsis and E. Coli.
Dr Gaid said Amanda had also “expressed anxiety” about going home.
Krista Holden, ward manager at Pine Cottage, said Amanda became medically fit to return home on September 22, but following a fall, that changed.
Ms Holden said that Amanda was advised about private care agencies she could seek help from after telling the team that she would require more daily visits than the NHS would fund.
On October 11, Amanda became medically fit once more, and she was discharged to her mother’s home on October 21.
“She said she was going home to die as she would not manage alone,” Ms Holden added.
Amanda’s physiotherapist Susan Flute also told the inquest that she had not attended many therapy sessions, and had therefore never reached a point where she could use her prosthetic limb due to “pain, her compliance and other issues”.
The court heard that after two weeks at her mother’s Necton home, Mrs Griffin found her daughter unresponsive at 7.45am on November 3, having left her with only the correct dose of her prescribed medication the night before.
“She didn’t take any other medication as an overdose – she was unable to open the bottles and was wheelchair-bound,” Mrs Griffin added.
She told the court that CPR had been attempted, but was unsuccessful.
“In my opinion, Amanda was passed from trust to trust, with relief on their part as she was a very complex case,” Mrs Griffin said.
Dr Ashraf Ibrahim, consultant histopathologist, gave the cause of Amanda’s death as due to morphine, gabapentin and meptazinol intake, with COPD, type 1 diabetes and renal infarction (referring to the compromise of arterial blood supply to the kidney) being contributing factors.
“Overall, there’s toxicological evidence to suggest that she used a number of drugs prior to death,” Dr Ibrahim said.
“The significance of those findings would be highly dependent on the level of tolerance on the deceased at the time of death.”
Summing up the evidence, assistant coroner for Norfolk Johanna Thompson said on the day of Amanda’s death, “the post-mortem evidence says there was excessive medication found in her system which was contributed to by her underlying health issues”.
She added: “There is no evidence before me to say that Amanda had taken a deliberate overdose of her medication apart from the earlier comment which was some weeks prior to that.”
There was also no evidence to suggest that she had taken an accidental overdose, the coroner said.
“In those circumstances I am unable to give a conclusion of suicide or accident.”
Ms Thompson concluded that Amanda’s death was drug-related, of prescribed medications.
She offered her “sincere condolences” to Amanda’s family who were in attendance at the inquest and said: “I realise it has been a very traumatic time for you all.”
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