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News archive for December 12, 2013

Forensic Pathologist reaffirms her conclusions

The forensic pathologist who performed Teresa Scheunert’s autopsy stands by her conclusion that the most likely cause of Scheunert’s death was mixed-drug toxicity.

By Ainslie Cruickshank on December 12, 2013 at 4:43 pm

The forensic pathologist who performed Teresa Scheunert’s autopsy stands by her conclusion that the most likely cause of Scheunert’s death was mixed-drug toxicity.

Her findings were challenged in an external patient safety review ordered by the Yukon Hospital Corp. (YHC), the results of which were made public Wednesday.

Dr. Robert Robson, an emergency room doctor with experience conducting patient safety reviews, was hired by the YHC to investigate Scheunert’s death.

He suggested Wednesday it’s more likely she died from a cardiac arrhythmia associated with sleep apnea.

Dr. Carol Lee, the forensic pathologist who performed the autopsy, told the Star she doesn’t disagree that Scheunert died of a cardiac arrhythmia.

“Basically, what the term means is that the heart goes into an irregular rhythm and stops, which is the process that happens in every death,” she explained, calling it a “non-specific term.”

But “what we’re interested in as death investigation people would be what actually caused the cardiac arrhythmia in the end,” she continued.

Robson explained Wednesday he doesn’t believe Scheunert’s death was caused by mixed-drug toxicity because she didn’t display any behaviour consistent with a drug overdose in the hours before her death.

He explained that an hour before she died, a nurse noted she was sleeping peacefully with a normal respiratory rate, which would be inconsistent with an overdose of medication.

Lee, on the other hand, said it was noted in her medical records that she was “exhibiting effects” that could have been from the drugs prior to her being found dead.

Lee did not have her report nor the medical records on hand Wednesday to reference specifics.

“I think the medications more likely than not had an effect on her, and that’s all I can say,” she said.

In the coroner’s report from July 9, 2013, it’s noted that Scheunert reported feeling “groggy” and “whacked out” to hospital staff on June 18, and was reported to snore loudly when sleeping.

Robson also argued it’s well understood that levels of fentanyl particularly can increase in the blood following death, which, he suggested, could impact the reliability of the toxicology findings.

He also noted that while the levels of pain medication prescribed to Scheunert could be lethal to an average healthy person, her body had adapted to handle higher doses over the course of her treatment for chronic back pain.

Speaking Wednesday via video conference, Robson said he believes Scheunert’s death was more likely caused by sleep apnea – a condition both doctors said would not show up in an autopsy.

Scheunert, he said, exhibited a number of characteristics that make obstructive sleep apnea a plausible contributing factor to her death.

He couldn’t say for sure, however, that she suffered from the disorder and specifically noted there was nothing to signal to her residing doctors or nurses that she should be monitored to determine whether she did indeed suffer from obstructive sleep apnea.

He determined that it was possible she had sleep apnea because there were references to loud snoring from time to time. But, he added, not everyone who snores suffers from the disorder.

“(Sleep apnea is) a condition that I cannot see at all because it’s a functional condition,” Lee explained, “so I cannot say yea or nay to that.”

But she added that if Scheunert did suffer from the disorder, the sedatives could have been even more harmful to her, and doesn’t rule out the medications as a contributing factor.

In her final report to the coroner, Lee noted that Scheunert did have a big heart, which could simply be incidental or could predispose her to an irregular heart beat, such as a cardiac arrhythmia.

“However, the post-mortem toxicological analysis showed a significantly elevated concentration of fentanyl, one that cannot be ignored, because it is within a range reported in lethal cases,” she said Wednesday.

There is no evidence that Scheunert had suffered any acute or chronic injuries in the heart, she added, and there was no record to suggest she had an arrhythmic disorder.

While both Lee and Robson said the effects of fentanyl vary between people depending on habit of use, Lee maintains that because Scheunert exhibited effects from either the fentanyl or a combination of the medication she was taking, and because she had no clearly documented history of a heart condition, that the medication was likely an important factor in her death.

Scheunert died on June 21, 2012 at the age of 47.

Her death was originally attributed to a heart attack, which was ruled out following the autopsy.

Her sister, two daughters, and the NDP have, since earlier this fall, called for a public inquiry into the death.

They have cited numerous unanswered questions, the discovery of two coroner’s reports into the death and now two different possible causes of death.

See related story below.

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