'No monitoring' in patient fatality

Early treatment of Mrs Touche "could have saved her"

An anaesthetist has told an inquest vital blood pressure levels were not monitored during or after a Caesarean birth of a woman who later died.

Laura Touche died from a stroke days after giving birth to twins at the exclusive Portland hospital in London.

On Wednesday, St Pancras Coroners' Court in London was told anaesthetist Dr Michael Kean had recorded blood pressure levels from memory the day after the operation.

He told the hearing he failed to properly load paper into a printer on a blood-monitoring machine before the operation began.

I think because everything had been so normal and straightforward I can only say it was an oversight

Dr Michael Kean

Mrs Touche, a direct descendant of former US president Thomas Jefferson, died from a brain haemorrhage nine days after the operation in February 1999.

Mrs Touche's husband Peter, whose great grandfather set up the chartered accountants that developed into the firm Deloitte and Touche, fought for the right to an inquest into his wife's death.

Her sons, Alexander and Charles, survived the birth.

At the hearing Dr Kean agreed with coroner Dr Susan Hungerford that if hypertension had caused the haemorrhage early treatment would "probably have prevented the fatal outcome".

The Portland treats celebrity patients

Mrs Touche's husband and parents earlier asked Dr Kean to reassure them that no mistakes had been made in her treatment.

However, the medical staff did not say she had not been monitored for two-and-a-half hours during and after the Caesarean.

Dr Kean described how he forgot to put paper in the machine which printed out blood pressure readings, and said it was an "oversight" that this was never mentioned to Mrs Touche's family.

He said: "I think because everything had been so normal and straightforward I can only say it was an oversight.

"The next day I wrote a statement and I recorded the blood pressure from memory."

He added his anaesthetist records did not show when drugs were administered during the operation.

Questioned by Mr Havers, Dr Kean agreed it was "inexcusable" that the records were not taken.

Speaking about the actual operation, Dr Kean told the court that at one stage, Mrs Touche's blood pressure increased.

'No record'

Although she had been given an anaesthetic which might have the effect of bringing the blood pressure down, he said the "blip" was not unusual and did not cause concern because it was still within normal limits.

Dr Stephen Porter, the resident medical officer who attended to Mrs Touche after the birth, said there was a one hour delay between midwives realising her blood pressure was high and giving her drugs to bring it back down.

He received a call at 0140 GMT from a midwife telling him what the situation was, and he visited her to assess her condition.

Administer drug

She said she had a headache and it was "the worst she had ever had," he said.

He said: "The only thing that was of concern was that she had a severe headache which she said she didn't normally get and a high blood pressure.

"I wasn't unduly worried, I thought with treatment it would settle."

Dr Porter telephoned Ursula Lloyd, the consultant obstetrician who oversaw Mrs Touche before, during and after she had given birth, and asked for her advice.

Dr Lloyd told him to administer the drug Nifedipine to bring her blood pressure down, and he went in search of it with the night nurse on duty.

He said: "We searched for it on the ward and it wasn't located. We couldn't find it."

The court heard that by the time the drug was found and administered by the midwife it was 0240 GMT and within 15 minutes Mrs Touche's blood pressure was normal.

Grace Bartholomew, the midwife who attended Mrs Touche after she had given birth, said during evidence that she had not taken any observation, such as blood pressure, pulse or temperature, because she was busy.

She said that Mrs Touche has appeared to be in good health.

No observation

"Her general observations, which one makes by looking at her skin temperature to touch, was fine so I didn't do anything," she said.

"There were several (other patients), it wasn't just the one. It was part of being busy and Mrs Touche appearing well."

Ms Bartholomew said the first time Mrs Touche complained about a headache was when she left for her break.

She said she handed over to another midwife and told her to administer an alagesic (pain relief).

However she agreed that it was "inexcusable" that she had not taken any observations during the time she was responsible for Mrs Touche.

The hearing continues.