The UK Health Security Agency (UKHSA) has explained its role in investigating the case of a woman who died following an E. coli infection after being criticized in a coroner’s report.
An inquest concluded that Laura Farmer died from a stroke caused by an E. coli infection.
Following a diarrheal illness about 10 days earlier, the 46-year-old was admitted to University College Hospital in April 2024. She was diagnosed with hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing E. coli (STEC). When thought to be in the recovery phase, she suffered an unexpected stroke and died.
Coroner Mary Hassell said UKHSA was not called to give evidence at inquest as she had expected the agency would have shared relevant information with clinicians and the family.
“During the inquest, the evidence revealed matters giving rise to concern. In my opinion, there is a risk that future deaths will occur unless action is taken. After death from E. coli, there seems to have been no closing of the loop of safety information that could have assisted those most closely involved,” she said.
UKHSA’s role in the investigation
Hassell said Laura Farmer and her family found her E. coli infection challenging to understand. She was a vegan who took great care with food preparation. As a family, they were extremely hygiene conscious, particularly as one of them has a nut allergy.
UKHSA said as its officials were not contacted, all the relevant evidence was not considered in the coroner’s Prevention of Future Deaths report.
The coroner said UKHSA did not ask Laura’s husband Steve for information to assist in finding the source of the E. coli infection. If asked, Steve would have explained that on one day in April 2024, they had visited a local restaurant, had drinks at a nearby club, and had recently eaten and drunk at local military establishments.
On April 25, Laura Farmer was interviewed by UKHSA South East about her condition while in the intensive treatment unit. She was asked for details about contact with water and animals, eating out, and people with a gastrointestinal infection. Laura was unsure of five details, so she asked the agency to send her an email so she could check with her husband.
One day later, UKHSA South East called to ask whether she had obtained the additional information but was unable to make contact. On April 29, after further unsuccessful attempts, UKHSA South East was told Laura had died.
UKHSA South East agreed that no further contact should be made. UKHSA South East considered that the family was grieving. A judgement not to speak to the next of kin was taken on the basis that public health actions had been completed, the risk of ongoing transmission in the household was extremely low, both household contacts were well at the time of the interview, and a significant time had passed since Laura Farmer’s onset of illness.
Respecting privacy vs need for information
Steve Farmer saw an E. coli outbreak in Waverley, Surrey. The clinicians at University College London Hospital knew which strain of E. coli had infected Laura but not whether that strain had been discovered in Waverley or elsewhere. After reporting to the UKHSA, they received no feedback, no advice on infection control, and no information they could give to Steve.
The STEC subtype causing Laura’s illness was E. coli O26:H11. Three other cases were microbiologically linked using WGS. UKHSA reviewed information on these four cases but did not find any common links between them nor any likely source of infection.
Around 1,500 cases of STEC are reported in England every year, with between 250 and 450 clusters detected, the majority of which are small, with five cases or fewer. UKHSA said it is often not possible to identify the source of infection for individuals, and investigations can be lengthy and complex.
According to the coroner’s report, Steve Farmer had spent considerable time and effort since his wife’s death trying to get basic information from public health authorities without success. He found it incredibly difficult to find the correct person to speak to and as difficult to gain any meaningful understanding of what had happened.
Hassell said this cannot inspire public confidence and seemed a very offhand way to treat a grieving relative.
In mid-June, a UKHSA South East senior clinician called Steve Farmer after he requested further information about his wife’s illness. He said he had been unwell with diarrhea after Laura’s death. He was advised that Laura’s illness was unrelated to any outbreaks of STEC.
An informal peer review by UKHSA South East identified one learning point regarding dealing with unwell cases. When a person dies during an investigation, a risk assessment should be undertaken with the clinical team treating the case to determine whether additional contact should be made with the next of kin. The privacy of a grieving family should be weighed against the potential need for information.
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