A 'devoted' family man caught Covid-19 in hospital and died, weeks after being admitted with severe back pain. A consultant from Stepping Hill Hospital in Stockport told an inquest that the virus "most likely" came from a staff member who did not know they had it
South Manchester Coroner's Court heard that Malcolm Garrett, of Marple Bridge, had received a lung transplant eight years earlier and as a result was immunosuppressed. Following the 61-year-old's death, a senior coroner has vowed to write a prevention of future deaths report to the Health Secretary, to try and "avoid and minimise the risk of immunosuppressed transplant patients in acute settings".
Mr Garrett's daughter Laura told the inquest that since his transplant, he had not been as active or mobile as before but that he had "gained a new perspective of what was manageable with his level of ability".
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On July 31 2021, Mr Garrett started to complain of a bad back and when things got worse on Monday (August 2) his wife Yvonne rang his GP. After being told that there would be a two or three hour wait for a telephone consultation, Mr Garrett asked his wife to ring him an ambulance.
“If Malcolm could keep out of hospital, he wouldn’t go in so for him to volunteer… it was the first time I’d known it," she told the court. “He left the house at half past five on Monday evening and never came home again.”
Upon being admitted at Stepping Hill Hospital, it was discovered that Mr Garrett had a wedge fracture of his T9 vertebra in his spine. The inquest heard that this was likely to have been caused by osteoporosis - a side effect of the steroids that Mr Garrett took following his lung transplant.
Dr Alexander Tempowski, a respiratory consultant at Stepping Hill Hospital, told the hearing that the fracture caused "a number of difficulties". Mr Garrett was fitted with a brace to help manage the pain from the fracture but the fitting of the brace led to respiratory problems and it was eventually removed.
However, even when the brace was off, the spinal fracture would have made it painful for Mr Garrett to breathe. Instead, Mr Garrett was given codeine and morphine as Dr Tempowski told the court that not being able to breathe "in a normal fashion" would have led to a risk of Mr Garrett contracting pneumonia while in hospital.
Dr Tempowski said that between August 3 and 7, "one of Mr Garrett's kidneys stopped working". This led to opiate toxicity because his kidney was unable to excrete the painkillers that had been given to him. Mr Garrett had to be given Naloxone to treat the toxicity.
He then developed pneumonia and was given antibiotics through a drip but deteriorated and was given oxygen through non- invasive ventilation (NIV). Towards the end of August, Mr Garrett was "stabilising", Dr Tempowski said, and efforts were being made to "wean him off" the NIV.
At the start of September, he caught an infection and started to deteriorate again. Dr Tempowski said that he showed signs of improvement on the week beginning September 14 but was deteriorating again by September 17.
On September 19, he tested positive for Covid-19, which Dr Tempowski admitted would have been caught in hospital and that it was "most likely from a staff member who didn’t know they had Covid."
He added: “My view would be that Covid was the main cause of his deterioration. We’ve acknowledged that Covid was caught in hospital and unfortunately as much as I’d like to say there’s something we could have done, it was a recurrent theme because of how infectious Covid was."
Mr Garrett was moved to a Covid treatment ward but died on September 23.
Following a post mortem, pathologist Prof Christopher Hunt found that Mr Garrett died from a combination of Covid pneumonitis and pseudomonas aeruginosa bronchopneumonia. He said that chronic immunosuppression, chronic allograft dysfunction, the wedge fracture, ischemic heart disease and chronic kidney disease were all contributory factors.
Recording a narrative conclusion, senior coroner Alison Mutch said: "He died from Covid-19 while an inpatient that was contributed to by the complications of a lung transplant."
Ms Mutch also said that she would write a prevention of future deaths report to the Health Secretary Sajid Javid. "Clearly management and risk of immunosuppressed transplant patients in an acute setting is something that has to be considered as a long-term issue within the NHS," she added.
"The person best placed consider how that should be managed to avoid and minimise the risk that is presented to these patients is clearly the Secretary of State for Health."
Speaking to the Manchester Evening News following the hearing, Mr Garrett's family said: "He was devoted to his family and we've just lost such a big part of our life."
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