A coroner’s jury returned an open verdict on Tuesday after hearing evidence last week concerning the death of Tanya Edith Welcome Joseph.
Mrs. Joseph, 31, died on Sept. 25, 2010 at Chrissie Tomlinson Memorial Hospital.
Coroner Angelyn Hernandez reminded jurors of the evidence they had heard over four days and instructed them on the possible verdicts. When the evidence is not sufficient for jurors to reach one of the verdicts provided in the 2015 Coroners Law, their verdict shall be open, she explained.
“Open” means they have unanswered questions and cannot definitively state the cause of death, she said.
The coroner noted that of the several medical experts who had given evidence, “not one of them could definitively state the cause of death.”
The coroner warned jurors not to speculate or come up with their own theories. She reminded them that it was not their function to determine any civil or criminal liability. Further, they did not need to be sure of their verdict beyond reasonable doubt; the standard was “on the balance of probabilities.”
Mrs. Joseph underwent gall bladder surgery, which ended at 10 minutes after midnight. She received pain medication at 1 a.m., was observed asleep at 2 a.m., asleep and snoring at 3 a.m., and then found unresponsive at 5:35 a.m. Resuscitation efforts continued until 6:40 a.m., when she was declared dead.
Government pathologist Dr. Shravana Jyoti, who conducted the autopsy, said the surgery was not the cause of death.
Other experts were consulted after the autopsy. Their evidence, via video link, centered largely on the various drugs used before, during and after the surgery, and the frequency of monitoring of Mrs. Joseph after she was transferred back to the ward. The experts included pathologists and toxicologists from the U.S., Jamaica and the U.K.
One of the last local witnesses to give evidence was the woman’s husband, Robert Douglas Joseph. On Thursday he told jurors he heard his wife complain of stomach pain in late 2009 or early 2010 and he recounted her visits to doctors. In September 2010, a consultant doctor told her she needed to have to matter dealt with immediately and there was a specialist at Chrissie Tomlinson. She was also told it was a routine procedure.
Mr. Joseph said his wife was comfortable with going to the hospital and he dropped her off there on Friday morning, Sept. 24. He checked with her throughout the day; when he went to the hospital around 4 p.m., there were still two surgeries scheduled ahead of hers.
At 9 p.m., she was still waiting and Mr. Joseph said he told his wife he was coming to get her, partly because it was late, partly because his wife was weak from not having eaten all day and because he thought the doctor would be tired from working all day.
The surgeon, Dr. Christopher Bromley, assured him he was fine and ready to go.
Mr. Joseph said he left the decision to his wife, who told him, “You know the pain I get when I have these episodes. I need to be OK for the baby and for you.” He asked if that was her final decision, and she indicated it was.
He said she phoned him at 1 a.m. to say she was out of surgery and in pain; she told him she was going to call the nurse.
Some time after 6 a.m. he got a call; the caller told him to come to the hospital.
Jurors had already heard that Mrs. Joseph received the pain medication Pethidine at 1 a.m., that she was checked at 3 a.m. and found unresponsive at 5:35 a.m.
Earlier in the week, Dr. Bromley gave his evidence. He explained Mrs. Joseph’s medical history and placed her need for surgery in a high category. On Sept. 24, he had four surgeries scheduled. The first two ran longer than expected. When they were finished, the hospital still did not have insurance approval for Mrs. Joseph; approval did not come until later that night.
Dr. Bromley said he got word that Mrs. Joseph did not want surgery that day. He went to speak to her and she said she had changed her mind on her husband’s advice, but she was keen. When he told her all the elements were in place, the staff was refreshed and ready, Mrs. Joseph called her husband and asked him to come back to the hospital.
After he came, he was positive he did not want her to undergo surgery but said it was her decision. Mrs. Joseph said she wanted to go ahead.
Dr. Bromley said the surgery was uneventful; the consultants who reviewed his notes agreed.
Dr. Stephen Gay, anesthetist for the surgery, gave evidence about the various drugs administered.
Consultant experts said the drugs and doses used were consistent with standard practice.
One drug in particular, the pain medication Pethidine, was examined because the level of the drug in Mrs. Joseph’s blood was higher than expected.
Dr. Jyoti had suggested Pethedine toxicity as the cause of death, with “complication of polydrug toxicity in therapeutic levels” considered a contributing factor. He emphasized that he was not a toxicologist; that was why he had sent various samples for laboratory testing and had then discussed the results with others.
Four doctors consulted after the inquest said the doses administered by injection were appropriate and did not constitute an overdose. Further, the hospital log for dangerous drugs was checked and the stock of Pethidine on hand was consistent with what the log showed had been taken out.
Mrs. Joseph had been prescribed Pethidine in pill form previously, but there was no trace of the pill in her stomach content. One explanation put forward was that if she took the medication for weeks or months, it was stored in her organs and then leached back into her blood after her death.
On the issue of post-surgery care, the coroner summed up evidence about how often Mrs. Joseph should have been monitored. She pointed out that Dr. Steve Tomlinson, hospital owner and chief executive officer at the time, had said his concern was not about the number of staff on duty that night, but about the number of patient observations carried out.
One pathologist who gave evidence had said there was nothing intrinsically wrong with not being able to say why a person died. Several of the experts agreed that, for as many as one in 20 cases, no cause of death can be determined.