Marjorie Cybil Bassendine · Prevention of Future Deaths report

On 9th October 2015 I commenced an investigation into the death of Marjorie Cybil Bassendine, 98 years of age. The investigation concluded at the end of the inquest on 13th October 2016. The medical cause of death given was:

1a. Cardiac Arrhythmia
1b. Long QT Syndrome
1c Therapeutic drug use

2. -

My conclusion was: Died from a recognised complication of necessary therapeutic agents.

Despite her advanced age, Mrs Bassendine was a relatively fit 98 year old lady who lived independently in a care home. On the 2nd October 2015 Mrs Bassendine was eating breakfast in the dining room of her residence when she was observed by several fellow residents sitting at the same table to suddenly collapse. Despite active and prompt resuscitation by the care home staff and subsequently by the paramedics who attended, Mrs Bassendine did not recover and she was declared dead at the care home shortly thereafter.

A Post mortem examination was undertaken and it was thought the cause of death was a consequence of choking by the pathologist finding food in the lungs and airways. However, during the hearing I heard evidence that there was any choking prior to the collapse. The collapse was sudden and Mrs Bassendine appeared to die immediately. There was no further signs of life despite active and prompt resuscitation by the staff at the care home and subsequently by the paramedics who attended after a 999 call was made. Mrs Bassendine had no history of choking and was able to eat what she wanted, when she wanted.

I heard evidence that Mrs Bassendine had been prescribed Olanzapine and Mirtazapine as well as Indapamide and that this combination of drugs can cause long QT syndrome. It was also noted that her dose of Mirtazapine had recently increased.

In the absence of any circumstantial evidence and with direct eyewitness accounts of the nature of the collapse I concluded that it was more likely than not Mrs Bassendine's collapse was a consequence of a cardiac arrhythmia rather than by choking and the arrhythmia was more likely than not to have arisen as a consequence of long QT syndrome from the combination of drugs she was taking to control her distressing depression.

I also heard evidence that there had been no assessment of her cardiac status including an ECG despite this combination of Olanzapine, Mirtazapine and Indapamide medication increasing the risk of developing long QT syndrome.

1. To recognise use of multiple psychotropic medication has the potential to prolong the QT interval.
2. To undertake an Electrocardiogram (ECG) prior to commencing such medication.
3. To undertake regular ECG's to ensure long QT syndrome has not developed and to help plan continuing treatment.