Mum died after drinking too much water when nurses were ‘distracted by mobiles’
Serious mistakes and failings by the NHS were highlighted following the death of a woman who drunk excessive amounts of water.
Married mum-of-two Michelle Whitehead, 45, was also found to have been given a lower dose of diazepam than she needed and her consciousness level was not assessed after she was given sleeping pills.
Michelle was admitted to the Millbrook Mental Health Unit in Sutton-in-Ashfield, Nottinghamshire, on May 3, 2021.
She died days later after falling unconscious and being admitted to King’s Mill Hospital next door.
An investigation later found there was inadequate monitoring because ‘staff were distracted by the use of their personal mobile telephones’, against ward policy.
A jury flagged a catalogue of errors by the Nottinghamshire Healthcare NHS Foundation Trust during a nine-day inquest in Nottingham.
The inquest heard Michelle sustained an unsurvivable brain injury on May 5, which ‘on the balance of probability’ was because of an ‘acute over-hydration of water, leading to severely low sodium levels, causing swelling in the brain’.
A jury returned a narrative conclusion which cited failings including a delay in the duty doctor arriving on the scene, a 10-minute delay in admitting the paramedics to the building, and a delay of 15 minutes in her being placed into the recovery position.
Just one single observation was made by the staff nurse supervising her that day, and Michelle also had unsupervised access to water in her room.
The trust’s admitted failure to monitor her consciousness level also led to missed opportunities to detect her deterioration and seek earlier hospital admission, which the jury said probably more than minimally contributed to her death.
Michelle was put into the intensive care unit at the hospital and later died.
A statement from Michelle’s husband, Michael Whitehead, and his family following the inquest reads: ‘Michelle’s family are grateful to the coroner and her team as well as our legal council, Thomas Herbert, Amelia Sutcliffe and Anna McLeod.
‘This has been a very difficult process, and the way it has been handled by all involved has returned Michelle her dignity and given us a measure of comfort. I would especially like to thank the jury.
‘Throughout the inquest we have taken strength from their active pursuit of the truth.
‘As we travel forward, we would like them to know that they have helped me on the first step. We miss Michelle very much and will love her forever.’
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