SOMERSET health workers are to receive more training to help patients with limited mental capacity following the death of a woman who had been in a coma for 12 years.

Becca Smith died in a hospice in the county last October 2021, having been unconscious following a seizure and cardiac arrest.

Somerset Clinical Commissioning Group (CCG), which allocates the county’s health resources, reviewed the decisions leading up to her death, which occurred after Becca’s family and doctors agreed to withdraw her treatment.

Health bosses concluded clinicians need more training to ensure patients’ mental capacity is properly accessed and the family are closely involved throughout.

Becca, whose family said she had “an adventurous spirit”, she fell while climbing out of a window and fractured her hip in 2008 at the age of 34.

A fortnight later, she had a seizure and went into cardiac arrest, remaining unconscious despite her father’s attempts to revive her through.

She was diagnosed as having a hypoxic brain injury and was in 'a minimally conscious state' with little awareness of her surroundings.

She was admitted to a Yeovil care home with a prolonged disorder of consciousness in 2009.

Becca remained unconscious throughout her time there and was unable to communicate with health professionals or her family.

She received food, drink and medication through a tube and was given botox and physiotherapy to “manage contractures to her limbs”. During this time, she also developed diabetes.

Her needs were reviewed annually by the neurology department at Musgrove Park Hospital.

From February 2019, Becca was frequently admitted to A&E, first for pnuemonia and later for sepsis, leading to discussions with her family into whether continuing treatment was in her best interests.

Yeovil Hospital’s ethics committee formally approved a decision to withdraw treatment in May 2021, and Becca died “in a planned and peaceful way” at St Margaret’s Hospice aged 47.

The conclusions of the CCG's review of the decisions leading up to Becca’s death have now been published.

Emma Savage, the CCG’s deputy director of quality and nursing, said: “Becca’s family felt that they lost her at the time she had her cardiac arrest, some 12 years previously, and had not been able to mourn. They believed Becca was leading a life she wouldn’t have wanted.

“There were differing views within the family, with her father convinced she would get better, making a ‘best interest’ discussion difficult to have.

“The family reflected that the decision for Becca’s life to end was one that had been made collectively by the family and professionals involved. It was important to know and it was appreciated that Becca’s mother didn’t carry the sole responsibility for the decision that was made.”

The CCG has made a number of recommendations for how to improve care for patients lacking mental capacity.

Ms Savage said: “We need to change our approach to anyone who lacks mental capacity to consent to treatment.

“Becca’s family wished that they had been invited to more meetings and reviews so they understood and stayed involved.

“We need a better understanding of the meaning of next of kin, and clinicians need Mental Capacity Act training at the right level to undertake their roles.”

In light of Becca’s case, the CCG will be reviewing all its continuing health care assessments to “make sure we are asking the right questions”.

STORY: Local Democracy reporter.