Vulnerable man starved himself in hospital after being allowed to refuse food, inquest told
A former black cab driver starved himself to death in hospital after being allowed to refuse food and drink despite having a history of mental health problems, an inquest has heard.
Frederick Payne, 73, of Woodford Green, Redbridge, east London, weighed just 40.4kg (6st 4lbs) when he died at the Princess Alexandra Hospital in Harlow, Essex, on January 3 last year – 31 days after he was admitted.
He had a body mass index of only 13 when a healthy score for a man is between 18 and 24.
A pathologist found Mr Payne (pictured) was “cachectic” at the time of his death – a term describing acute emaciation and muscle wastage usually found in late-stage terminal cancer or Aids patients.
Despite this, the hospital had been preparing to discharge him in the days before his death, Essex Coroner’s Court heard.
In a letter to the hospital following his death, Mr Payne’s wife of 43 years Laraine said: “How did my husband end up looking like a stinking, unshaven and disheveled tramp lying on a hospital floor?”
The inquest heard Mr Payne had previously been admitted to a psychiatric ward, suffered from depression and anxiety and had signs of dementia, but staff at the hospital made the decision that he was rational enough to refuse food.
On certain days, Mr Payne would refuse food and drink, blood tests or a drip, although he would accept them on other days depending on his mood, the inquest heard.
Pathologist Dr Peter Davis said: “The patient’s mental capacity was assessed at various times and he was found to have capacity and therefore in a position to refuse anything he chose to refuse in this case, including food.
“On January 2, he was considered to be fit for discharge.”
The court heard medical staff then changed their minds and made the decision later that same day that Mr Payne should be fed by a nasogastric tube, but he died of a heart attack the following day before this could take place.
Two weeks into his stay in hospital, Mr Payne was treated for a difficulty swallowing due to a problem with the muscles in his oesophagus – a condition called achalasia that can be treated with Botox injections.
On December 18, consultant gastroenterologist Rosemary Phillips decided Mr Payne should undergo the injections but that he did not have the capacity to understand what it was or how it would help him.
Dr Phillips told the court: “He told me he just wanted to be normal and said he didn’t see how food could help him as he was just wasting away.
“I thought he didn’t understand how this procedure would help him and (asked him to) repeat the process back to me?
“He didn’t repeat back anything about the procedure, he just said, ‘I’m a man who used to love food’.”
She concluded she needed to sign the forms herself permitting staff to go ahead with the procedure without Mr Payne’s permission.
Despite being deemed not to have capacity to consent to the medical procedure, Mr Payne was still allowed to refuse food.
The hospital acknowledged “opportunities were missed” in the treatment of Mr Payne, and said it was in the process of developing a food and drink refusal policy.
June Barnard, associate director of nursing at Princess Alexandra Hospital, said: “There were opportunities to assess Mr Payne’s medical capacity in a more formal way for decision-specific reasons and we missed those opportunities.”
The North East London NHS Foundation Trust, which had been responsible for Mr Payne’s mental health treatment before his admission to Princess Alexandra Hospital, also vowed to improve standards and improve communication between care providers.
Coroner Caroline Beasley-Murray recorded a verdict of death caused by starvation, listing Mr Payne’s achalasia, depression and anxiety as secondary causes.
She said: “Frederick Edward Payne died of natural causes complicated by medical treatment.”
His wife of 43 years, Laraine Payne, said: “I knew Freddie for over 50 years and his passing has left our daughter Laura and I truly devastated. Freddie was such a strong man, a wonderful father and we miss him terribly.”
She added: “We are incredibly angry that we lost Freddie when he could have been saved. We loved him so much and will miss him forever.”
Nicholas Leahy, specialist clinical negligence lawyer at Osbornes Law, who represented Mrs Payne, said: “Mr Payne became very unwell and he had lost a substantial amount of weight, yet incredibly he was considered to be able to make his own decisions about refusing food while he was in hospital.
“It is shocking that he was effectively allowed to starve himself to death while in hospital, where he should have been safest.”
Mrs Payne and the couple’s daughter Laura, Mr Payne’s brother Gary and sister-in-law Christine were all present at the inquest.
Copyright (c) PA Media Ltd. 2020, All Rights Reserved. Picture (c) Gary Payne / PA Wire.
