Woman died from tetanus after falling into garden pond, inquest hears

Jean Berry Walford is believed to have got the “exceptionally rare” disease from the bacteria - present in soil - getting in through a cut on her head.

Described as "fiercely independent", Miss Walford lived alone and told a junior doctor at Salisbury District Hospital that while she had managed to crawl back into the house after she fell, she had not been able to get herself up or even call for help and had spent two days on the floor, surviving off sandwiches and water.

It was only when she managed to call a friend that she was taken by ambulance to the Emergency Department on June 7, 2015.

In a statement read out during the inquest, the junior doctor described Miss Walford as bright, alert and in good spirits, saying she did not appear to be in any pain but looked malnourished and showed evidence of prolonged self-neglect with ingrained dirt and an "impenetrable cap" of hair which was solidly matted and caked in mud.

Once cleaned up, Miss Walford, from Mere, was taken to a general ward, being given treatment for issues relating to concerns over her being malnourished and to help prevent renal failure, a concern arising from high blood levels and having been lying on the floor for two days.

Both junior doctors and consultants who examined her said they did not ask her whether she had previously had a tetanus vaccine or even think about the disease as a possibility because they could only see superficial cuts, not "tetanus prone" deep wounds.

But on June 11, 2015, four days after she arrived in hospital, and six days after she had fallen into the pond, Miss Walford began showing a sign of the disease when she was unable to move her jaw.

Initially thinking she might have a sore jaw from falling on her head, it was only when she started having facial spasms, a classic sign of tetanus, that doctors made the diagnosis, giving her tetanus antitoxins and sending her to intensive care for treatment.

However, her condition deteriorated over the next few days to such an extent that it was made clear she was not going to recover and, after speaking with her family, the decision was taken to withdraw her breathing support and she died shortly after, on June 19.

Stephen Jukes, an intensive care consultant at the hospital, said that even had Miss Walford been given treatment for tetanus the moment she arrived at hospital, it is unlikely she would have survived because the toxins were probably already in her nerve cells.

The inquest heard that a national vaccination programme began in the UK in 1961 and that although men born before that time were likely to have received the vaccine having been called up for national service, females born before 1961 are not protected unless they have either actively sought it or been reminded by their doctor.

Emergency Department consultant Neil Robinson said he believed there was an assumption that patients aged in their eighties would have had the vaccine and that was a "potential area for error" leading to the hospital now training all staff, from consultants to nurses, to assume that females born before 1961 are not protected from tetanus.

However Dr Robinson who led a care review report into Miss Walford's death told the inquest her situation was very unusual.

He said: "She had this impenetrable mass of hair described like a crash helmet and that was probably the environment that was devoid of oxygen - the doctor seeing her didn't see a wound or recognise a wound at the time and didn't consider tetanus. I think that's the hard reality.

"I have spoken in detail to my two junior doctors involved in this who have now moved on to work in other parts of the country who cannot recall seeing any wound that was actively bleeding at the time.

"The grazes were not really top priority because of the real worry of bruising, her long lie on floor and the risk to her kidneys because of muscle breakdown when elderly and malnourished. All attentions were diverted to those issues."

He told the court that the prevention of tetanus was an emergency medicine issue not one for a general ward, adding: "I think it's important to remember in the 15 years I have been at Salisbury, supervising my staff and others through a journey of about 600,000 patients, this is the one case.

"It's not to say that we shouldn't try and do everything we can to try and prevent another case like this again but it is an issue that is extremely rare.

"We have to do stuff as early in the front door as we can as we can't expect our colleagues elsewhere to try and pick this up in the absence of tetanus prone wounds. This is our world."

The inquest took place at Salisbury Coroner’s Court last Wednesday and was heard by coroner Ian Singleton and a jury because Miss Walford had not been able to make decisions for herself before her death. The jury returned a verdict of accidental death.

Deaths from tetanus are very rare in the UK. In 2013, there were only seven recorded cases of tetanus in England and Wales, and no deaths.