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Fatal Accident Inquiry into the circumstances of the death of Mrs Jean Elizabeth Wilson [2010] FAI 53


In terms of section 6(1)(a) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976 the Sheriff found that Mrs Jean Elizabeth Wilson, date of birth 19 June 1939, had died in Monklands District General Hospital at 5.20 pm on 30 September 2006. The Sheriff found that in terms of section 6(1)(b) that the cause of her death was Multiple Organ Failure and Sepsis following Femoral Angioplasty carried out on 19 September 2006 and a significant blood loss into the tissues which occurred after 21 September 2006.

Having heard evidence on the deceased's medical procedures leading up to her death, and in particular, her kidney problems, the Sheriff concluded that there were a number of reasonable precautions which might have been made, whereby Mrs Wilson's death might have been avoided.

Firstly, the Sheriff found that an assessment of the state of Mrs Wilson's kidney function prior to a CT angiogram could have been out in Monklands District General Hospital on 12 July 2006 by means of taking a blood sample and the analysis of that by the Biochemistry Department. Secondly, there could have been an institution of steps to help improve Mrs Wilson's kidney function prior to her angioplasty e.g. encouraging an increase in the intake of fluids, the adjustment of her medication and the taking of further blood tests to assess her continued renal condition. Thirdly, the Sheriff also found that there also should have been a system in place whereby the Radiology Department had access to Mrs Wilson's blood results.

In terms of section 6(1)(d), the Sheriff found defects in the system of working which contributed to the deceased's death by the medical professionals attending to her, but noted that these defects had all been subsequently addressed by NHS Lanarkshire.