A Jehovah's Witness from Bishop's Stortford lost her life after refusing a blood transfusion in accordance with her religious beliefs – despite advice from doctors.
Barbara Mortimer, 69, of Portland Road, died on May 24, 2017, at the Rivers Hospital in Sawbridgeworth, shortly after a hip replacement.
A final hearing was held at The Old Courthouse in Hatfield yesterday (Wednesday, October 18) before Coroner Geoffrey Sullivan.
The court heard that in January of this year, Mrs Mortimer visited her GP Mark Penwell with "severe left hip pain."
Doctor Penwell said: "She was struggling to walk with it, even using a stick.
"The only useful intervention was a hip replacement."
He admitted however, that he had concerns about Mrs Mortimer, who would decline any blood products due to her being a Jehovah's Witness.
Doctor Penwell revealed her significant medical history including high blood pressure and heart palpitations.
Mrs Mortimer also suffered what was thought to be a heart attack in 2006 and acute coronary syndrome after having chest pain in 2010 – but tests proved these incorrect.
For her hip, Mrs Mortimer was referred to consultant orthopaedic surgeon Rajeev Sharma, who has carried out a number of hip and knee replacements since obtaining the position in 2002.
He said: "She came to see me in the clinic on Thursday, March 23.
"She came in with a diagnosis of hip arthritis on one of the sides.
"She had an X-ray that showed the joints were worn out."
Risks associated with the procedure including displacing the hip, heart attack and most commonly infection, were discussed with Mrs Mortimer.
Having elected to have the operation, a series of precautions needed to be taken to reduce the possibility of needing a blood transfusion.
This is because Mrs Mortimer was taking aspirin - a drug which thins the blood.
Steps included administering tranexamic acid, swabs soaked in adrenalin and a spinal aesthetic as opposed to general, as these all help to prevent and restrict blood loss.
Mr Sharma said: "We needed to be sure our surgery is in such a manner to prevent bleeding.
"It was safe to proceed providing we take all the necessary precautions."
The procedure went ahead with Mrs Mortimer's haemoglobin levels being within an acceptable range.
But during the operation after the joint was dislocated, the living part of the bone began to bleed.
The bleed then became "exponentially massive," according to Mr Sharma following the removal of hard cartilage.
The adrenalin swabs, an alternative method to stopping the bleed due to Mrs Mortimer's belief's, were inserted to constrict the blood vessels as well as a plastic membrane.
Mr Sharma said: "We continued with the procedure, it was the best way to stop the bleeding.
"I could not think why such a lot of bleeding would take place.
"Was it the aspirin? Would it have had a significant effect on her or was there an anomaly in the pelvic bone?"
Following the surgery, Mr Sharma spoke with Mrs Mortimer's family.
"The recommended blood products were declined," he said.
"We were struggling to keep her alive if we can't give her any blood. Persistent refusal was risking her life."
Mrs Mortimer faced the decision of accepting blood products or hope that the fluids given to her post-operation would stimulate cell production after such a huge blood loss.
She died during the early hours of the morning.
Mr Sharma was challenged in court by Counsel Kate Smith, who asked whether further enquiries should have been made prior to the hip replacement due to her age, religious beliefs, medical history and the fact she was taking aspirin.
Ms Smith presented a booklet in court regarding Jehovah's Witnesses and surgery.
It said "should avoid any medication that could increase blood loss," referring to aspirin which thins the blood and makes the likelihood of needing a blood transfusion more likely.
Mrs Mortimer signed a refusal form indicating her religious convictions that "no blood transfusions are to be administered in any circumstances".
Mr Sharma said in "hindsight" there are things that would have been done differently but at that stage all the safety precautions had been made.
The operation was also not considered to be life-threatening.
He was also challenged whether Mrs Mortimer needed to be on aspirin. The decision to take this course was made working on the basis that she had suffered a heart attack – later found to be untrue.
Coroner Geoffrey Sullivan, said: "I cannot see a short form conclusion.
"The adequate way to my mind is a narrative verdict to encompass blood loss [from the] surgical procedure and declining of blood products.
"She was admitted to Rivers Hospital, she had advanced decision not to accept blood products, and asked to consider accepting blood products, but declined to do so."
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