An English teacher who died of an overdose had attended an A&E department 28 times in the six months before her death, an inquest was told. Kimberley Drinnan, 35, had taken a "significant quanitity" of over-the-counter painkillers which led to liver failure in September 2019.
More than three years after the tragedy, an inquest was held at Bolton Coroner's Court yesterday (Wednesday October 5). Kimberley’s heartbroken mum Kathleen Drinnan told the court that her daughter had grown up in Kearsley before enrolling at Liverpool John Moores University to study Japanese.
Following her graduation, Kimberley moved to Japan where she found work as an English teacher and lived there for roughly 10 years, Manchester Evening News reports. However, after suffering a variety of “personal issues” - which Mrs Drinnan did not expand on - Kimberley returned to Bolton in 2017.
Later in the hearing, Kimberley’s care coordinator Philip Carroll made further reference to events in Japan. “There were a number of incidents that she reported and was quite open in making those reports to us in the time spent with her,” Mr Carroll said.
One of the incidents that he told the court about involved an ‘altercation’ in a bar in Japan, although he did not go into detail about the precise circumstances. Kimberley’s GP at Shanti Medical Centre, Dr Ratnarajah, wrote a report that confirmed she had been diagnosed with borderline personality disorder and emotionally unstable personality disorder.
Dr Ratnarajah also disclosed that Kimberley had a history of self-harm. Kimberley was alcohol dependent and was known to recovery services since January 2018, Natalie Derbyshire from Achieve confirmed.
As of August 2019, she was drinking one bottle of vodka per day, Dr Ratnarajah’s report said. Consultant psychiatrist Dr Sohi told the hearing: “Kim had reported quite a lot of traumas throughout her life and this led to a very shattered sense of who she was and where she belonged.
“There was a lot of self-deprecation, where her opinion of herself deserving good things was very low. Coupled with that was intelligence and dry wit, where she’d understand what course of treatment for her particular sets of difficulties was and what could and should be done in order to do that and the pitfalls of taking away her freedoms.
“What was really difficult for Kim was to reconcile what could be there and what she was actually going through. It was actually quite sad in a number of ways because she knew what had to be done and understood some of the acts that she did were in order to express her distress in terms of situations and get that comfort and care that she so desperately craved.”
A report from consultant in emergency medicine Dr Damian Bates revealed that Kimberley had presented to Royal Bolton Hospital on 28 occasions in the final six months of her life - with the most frequent reason being ‘intoxication’ and ‘overdose’. Dr Bates said that eight of these occasions were paracetamol poisoning. Of her presentations, she was referred to the safeguarding team 15 times and mental health services a further 10.
Siobhan Barlow, who was the manager of the Oak Ward during that time, described Kimberley as a “very intelligent woman” who understood her risk and felt “safe and supported” in the hospital environment. Ms Barlow said that on occasions, Kimberley would rip alarms from the wall and pour milk on the ward in a bid to be kept there, rather than being sent home.
When asked why they would not keep Kimberley on the ward in these situations, Ms Barlow said that there is a ‘bigger picture’ to think of and added: “We don’t want to enforce these behaviours.”
Dr Gareth Hughes, consultant in intensive care and respiratory medicine at Royal Bolton Hospital, confirmed that Kimberley was admitted to hospital on September 27 2019 following an ‘intentional’ overdose. She died three days later, at 6.17pm on September 30.
A post mortem carried out by pathologist Dr Patrick Waugh found that Kimberley died as a result of “fulminant liver failure, as a result of paracetamol overdose”. Forensic toxicologist Julie Evans confirmed that she had “excessive” amounts of paracetamol in her system, along with therapeutic levels a sedative that is often used to treat symptoms of alcohol withdrawal.
Following Kimberley’s death, external doctor David Chambers was tasked with writing a serious incident review, but Dr Chambers concluded that there had been “no missed opportunities and nothing to consider that might have had a bearing on the outcome”.
Senior coroner Timothy Brennand commended Greater Manchester Mental Health Trust (GMMH) as he recorded a conclusion of ‘misadventure’. He said: “This was an unintended consequence of a deliberate act to self-medicate and a high risk strategy designed by her to get herself into hospital for the full cycle of care that she had received in the preceding months, on no fewer than 27 other occasions.”
Addressing GMMH’s lawyer in court, he continued: “Can I commend the Trust? It is important that the Trust understands that this court can occasionally be critical but it’s equally the case where best and good practice is demonstrated that the court says so and I do say so in this case.”
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