Clarification

An elderly stroke victim begged for a beetroot sandwich and macaroni cheese in hospital but no attempt was made to feed her, an inquest was told yesterday.

Olive Nockels, 91, a former school matron, died after surviving for nearly a month on a subcutaneous drip that delivered only a quarter of the calorie intake specified by the World Health Organisation (WHO) as a short-term starvation diet.

Even that was stopped for four days when the hospital claimed that she was suffering from excess fluid.

Relatives told the inquest that doctors and the Norfolk & Norwich Hospital had no interest in treating Mrs Nockels after she was admitted in September 2003.

Her grandson, Christopher West, told William Armstrong, the Coroner, at the inquest in Norwich: “The only thing that was said most of the time, as the weeks went on, was that she hadn’t died yet.

“Immediately after her admission it became clear it was their intention not to treat her.”

Mr West, 34, obtained a High Court ex parte injunction on October 6, 2003, forcing doctors to reinstate artificial nutrition and hydration, but the next day Mr Justice Forbes varied the order on an application by David Maisey, a consultant.

In the amended version, nutrition and hydration were to be reinstated only “as far as medically possible”.

Mrs Nockels died on October 10, 2003 — three days after the amendments were made.

Mr West said that doctors told him that the quality of life of his grandmother would be so poor that “it would be in her best interests not to intervene and let her die”. He said: “You don’t just let someone die because you think it’s best for them. It’s inhuman. I would class it as starvation, actually.”

Mrs Nockels’s daughter, Ivy West, told the coroner that her mother’s hearing aid and dentures had been removed — for reasons given to her as comfort and safety. She denied that her mother, from Holt, Norfolk, was incapable of responding when she visited.

“I talked to her every day,” she said. “She would tell me she was cold and that she wanted something to eat. She told me she wanted a beetroot sandwich and some macaroni cheese. She could make decisions for herself.”

Michael Heath, a consultant pathologist who carried out a post-mortem examination, gave the cause of death as a stroke. Questioned by James Dingemans, QC, counsel for Mrs West, he agreed that the lack of fluids was also a possible cause of death.

Brian Payne, a retired consultant geriatrician, said that he had been asked by Dr Maisey to give a second opinion, and examined Mrs Nockels on September 30, 2003.

He said that she gave no response to questions that he asked about her having a stomach feeding tube fitted, nor to whether she wished or was ready to die.

He felt that it was “highly probable” that she would die.

Between September 14 and September 30, Mrs Nockels had received a daily intake of 140 calories from a subcutaneous infusion consisting of five per cent dextrose — a quarter of the 600 calories adequate for short-term starvation according to the WHO. From October 2 to 6 all artificial hydration of fluids was withdrawn.

The hospital says that it twice sought to give Mrs Nockels a nasal gastro tube but this had been impossible to insert.

Dr Payne was asked by Mr Dingemans: “If someone says, ‘I would like a beetroot sandwich’, does it help you decide on whether they need nutrition?”

Dr Payne replied: “It probably means they are hungry.” If a patient has lost the swallowing reflex as the result of a stroke he or she is in danger of aspirating, and so at risk of pneumonia, he said.

The inquest continues.