Megan Gardiner, 25, died on June 4, 2022 at her home in Barry from sudden unexpected death in epilepsy (SUDEP) while 17 weeks pregnant, and an inquest has now ruled that medical professionals responsible for her care had not sufficiently advised her of her own personal risk of death.
The inquest chaired by coroner Kerrie Burge at Pontypridd Coroner’s Court heard on Friday May 1 that Megan, who had been diagnosed with epilepsy at 13, had not been suitably informed of her risk of death, despite her suffering from frequent tonic-clonic seizures that were not controlled by any of her prescribed medications.
As part of the inquest, evidence was heard from Megan’s mum Alison Woolcock, who described her as “beautiful” and with a “wonderfully sarcastic sense of humour”, and a number of medical professionals, including epilepsy specialists who had direct contact with Megan.
Ms Burge said that Megan and her family would only have been aware “in broad terms” of the risk of seizures and of her risk of death and therefore couldn’t have properly protected Megan from this.
It was noted that there were “no documented references” or “specific recollections” of any discussions made with Megan or her family about her specific risks or the “mitigations” that could have been made to reduce the risk.
Ms Burge deemed that Megan’s decisions around her medications and pregnancy may have changed if she had been better informed.
Ms Burge said in her conclusion: “In the absence of documentation or recollection of specific discussions, I cannot be satisfied on the balance of probabilities that prior to April 2022, that Megan and her family were informed in clear terms that Megan was at high risk of sudden unexpected death in epilepsy.
“Understanding this risk would have contributed to discussions about appropriate medication management and opened up conversations on safety measures. But, there is insufficient evidence to determine what the outcome of these conversations would have been.”
The coroner also noted that there were two opportunities for “stronger support” of Megan by the medical professionals, namely in March 2020 as a follow-up to a medication change to confirm that it had actually taken place and in May 2022 after an appointment had been halted early as Megan had said she was “feeling overwhelmed”.
Ms Burge concluded that Megan’s death in June 2022 was natural causes and that the medical cause of death was Sudden Unexpected Death in Epilepsy (SUDEP), which, according to evidence provided, is “common” for people who suffer the types of seizure that Megan did.
This inquest was the first in Wales to consider the significance of SUDEP risk discussions in epilepsy care.
The epilepsy centre have also been asked to provide the coroner with a statement detailing changes made to their patient care since Megan’s death.
Why We Report on Inquests
Inquests are public hearings that examine the circumstances of sudden or unexplained deaths. We report on them to uphold open justice, inform the public, and help prevent future tragedies.
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