There were “missed opportunities” in the communications between the specialist doctors treating teenager Gaia Pope-Sutherland before she disappeared, an inquest heard.
As well as epilepsy, Miss Pope-Sutherland had been diagnosed with post-traumatic stress disorder after disclosing she had been raped by a man when she was 16.
Dorset Coroner’s Court heard evidence from neurologist Professor David Chadwick, who had been called to give his opinion on the care the 19-year-old had received.
She was diagnosed with epilepsy in 2013 and in November 2016 referred to a specialist in London, because her family wanted a second opinion. She was seen in March 2017 and recommended for brain surgery.
Prof Chadwick, an emeritus professor of neurology at the University of Liverpool, told the court Miss Pope-Sutherland had “severe and complex” and “unusual” epilepsy.
Asked how bad her epilepsy was, he replied: “It is being at the wrong end of the spectrum of severity that one is as likely to see.
“I would almost say she is unique in my experience. I have not come across the features she presented in my clinical practice.”
He told the court there was a “complex relationship” between epilepsy and mental health, and said that sufferers often struggled with anxiety and depression and could develop postictal psychosis after a seizure, which can “last for hours to days, possibly even a week or so”.
“I cannot exclude the possibility that her abnormal behaviour was a manifestation of a postictal psychosis,” he said.
“I don’t have the expertise to say that she had a psychological disorder as well as epilepsy.”
Miss Pope-Sutherland had been assessed by psychologists on three separate occasions between December 2016 and October 2017.
This included a period in a mental health unit in the February and March, but doctors had not informed the neurologists treating her epilepsy.
Prof Chadwick described this failure as a “missed opportunity” to review her epilepsy care.
Explaining why, he said: “It may well have been that changes might have been made to her anti-epilepsy drug treatment, but I think we were getting to a stage of a point in time where a significant improvement in the condition of her epilepsy was low.”
In July 2017 Miss Pope-Sutherland underwent a series of tests as part of her surgical assessments, but neuropsychiatric and psychological evaluations were omitted, despite a request for them, which Prof Chadwick also described as a “missed opportunity”.
Rachael Griffin, the senior coroner for Dorset, asked Prof Chadwick whether these collective failures amounted to neglect.
He replied: “I have difficulty answering that question because I am not quite certain about using the word ‘gross’, as if by gross you mean the effect of those omissions had a significant effect in the outcome that we are all very much aware of, then I wouldn’t use that term.
“If one says getting one thing wrong is perhaps excusable, but perhaps three or four things wrong you might use the term gross.”
He described Miss Pope-Sutherland’s overall epilepsy care as “reasonable” but said he would have expected her to be seen by a neurologist after July 2017, which never happened.
The court heard that Prof Chadwick was unable to say whether Miss Pope-Sutherland’s epilepsy contributed to her death.
Ms Griffin asked him: “You cannot say on the balance of probabilities that epilepsy contributed to Gaia’s death more than minimally, negligibly, or trivially?”
Prof Chadwick replied: “I think that’s right. On the balance of probabilities that epilepsy was a factor in Gaia’s death? I cannot say that.
“Could it have been? It’s possible that epilepsy was very much a cause of her death – that is certainly a possibility because we know isolated seizures can result in sudden death.”
The inquest continues.