Coroner’s jury determines death was from natural causes
In a recent inquest, a Coroner’s Jury determined that Alexandra Jane Horner died of natural causes after a sudden asthma attack at a social gathering on 27 December, 2010.
Evidence came from government pathologist Shravana Jyoti and Ms Horner’s companion, Nicholas Quin.
By way of background, Queen’s Coroner Eileen Nervik explained that Ms Horner was a United Kingdom citizen, 33, working in the banking industry in Cayman. She seemed to be in good health except that she suffered from asthma.
Mr. Quin described her as athletic, playing rugby, cricket, hockey and golf. He said she was a healthy, active person who smoked and drank on occasion, but suffered from severe asthma. She used her inhaler daily and during sports.
“She lived life to the fullest and was always striving to achieve more and push herself to the next level. She worked hard in a stressful job, but also played hard with a motivation to win,” he said in a written statement.
Mr. Quin reported that they both drank socially over the Christmas holidays. On Boxing Day, she played hockey and said she had struggled because of the heat. This did not concern him, since anyone who plays sports in the heat will know the effects.
On 27 December, they attended a cricket fundraiser, arriving about 1pm. The event was a round of games in various sports for teams of six. Teams got points at the end of each game; top-up points could be earned by drinking alcohol while competing. The games finished around 6pm.
The last game they competed in was pool and to earn extra points they both consumed three shots of rum. Both of them were getting merry, but Ms Horner was not drunk, Mr. Quin said, explaining that, because of her competitive nature, she had been pacing her alcohol consumption and was also drinking plain cola. She then took part in “a boat race drinking game” and had a bottle of beer.
Mr. Quin noted there were 60 to 70 people at the event and both he and Ms Horner were mingling, as they did not feel the need to be with each other constantly. He was not sure of the time, but someone told him Ms Horner was having an asthma attack on the main patio. He assisted her to walk away. She was struggling to breathe and tried to use her inhaler, but it was empty.
A friend put her on the floor with arms outstretched in an attempt to open her airway. The host made a call for anyone with an inhaler to come forward. It was clear her condition was deteriorating and an ambulance was called. He thought she was on the floor about 10 minutes when the ambulance arrived. He saw the paramedics giving her oxygen and cardiopulmonary resuscitation. He travelled with her to the hospital, where she never regained consciousness.
The autopsy report stated that Ms Horner was transferred to the Intensive Care Unit, where she received advanced life support and was maintained on a ventilator for four days prior to death. Mr. Quin said he and Ms Horner’s parent were present when the ventilator was switched off.
The autopsy report was prepared by Dr. Cheryl Reichert, who stated: “Acute severe asthma is a potentially lethal condition. With chronic asthma it is often difficult for a patient to appreciate the severity of the attacks. This may be because the perception of breathlessness appears to be less in patients with chronic airflow obstruction.
“As in the tragic case of Ms Horner, often there is a background of escalating deterioration over several days to weeks preceding the fatal attack. In some cases there is an identifiable ‘trigger’ for the fatal attack. Alcohol has been reported to be a trigger for some asthma attacks and may have been the trigger in this case,” Dr. Reichert said. “In addition, inebriation may have also limited the patient’s perception of the severity of her condition.”
Dr. Jyoti attended the inquest to assist the jury in understanding the autopsy report. He said asthma is a sensitivity of the airway toward a stimulus. Various stimuli can trigger an attack by compressing the airway and the person will have difficulty breathing. The person has to be treated immediately by an inhaler that opens the airway.
He also noted that when a person cannot breathe for three or four minutes, the higher brain functions, such as speech, suffer from lack of oxygen.
The jury adopted the physical cause of death from the report – sudden onset severe acute asthma attack in patient with chronic asthma.
The report added acute alcohol intoxication as another significant finding.