No direct evidence of intent to harm patient who died after operation, inquest told

No direct evidence has emerged of intent to harm a hospital patient who died with high levels of unexplained insulin in his system, an inquest has heard. A police investigation was launched and doctors questioned when Donald Gough deteriorated unexpectedly after surgery at University Hospital of Wales in Cardiff. There was no reason for the bowel cancer patient, who was not diabetic, to have been given insulin. On the fifth day of an inquest into his unexplained death, coroner David Regan said there was no direct evidence of intent to harm and no evidence that anyone had unauthorised access to Mr Gough's medical records. For the biggest stories in Wales first sign up to our daily newsletter here He said the pathologist recorded the cause of Mr Gough's death as encephalopathy - a broad term for a condition causing brain impairment - caused by hypoglycemia (low blood sugar). But it remains a mystery as to how unexplained high levels of insulin got into his system, the hearing at Pontyrpidd Coroner's Court has heard. The coroner explained to Mr Gough's family, who have attended throughout the week-long hearing, that the inquest would continue into next week. He said he understood the proceedings could " re-traumatise" them. Closing the hearing on Friday June 5, before it resumes next week, Mr Regan told Mr Gough's family in court "You have had a very long week. Inquests can re-traumatise people. Try to rest over the weekend." He said there was "no evidence of intent to harm" Mr Gough although police "properly and clearly considered the possibility there was some intended nefarious action." Medics have told the hearing in evidence over the last five days that there was no reason for insulin to be given to the 77 year-old at any time during his stay in hospital where he underwent an eight hour operation to have secondary tumours in his liver removed. Mr Gough was not diabetic and did not need insulin. Doctors had assessed the risk of him dying from the procedure as less than 5%, yet he never woke up afterwards. The inquest has heard from surgeons, theatre staff and nurses involved in his care, all of whom denied giving him insulin or that they had seen anyone else do so. All also insisted it would not be possible to muddle insulin with other drugs and they had not done so. On Friday 5, Dr Manesh Pandy, substantive consultant in intensive care medicine, told the hearing that he was never given the expected one to one hand over from the consultant anaesthetist for Mr Gough's surgery. This made it harder to assess what was happening when he failed to wake. Dr Benjamin Holst had earlier in the week broken down in tears when he admitted leaving his patient before he awoke and without the handover he should have provided. Giorgio Alessandri, who carried out the surgery, and the two junior doctors who stitched Mr Gough up at the end, all told the hearing they thought the operation had gone well and had no concerns at the time. But in the recovery room afterwards it became obvious to nurses that something was amiss when Mr Gough failed to wake after an hour, as expected. Dr Pandy, who was called to assist by the team in the recovery room told the coroner that the lack of expected handover from Dr Holst meant it had been a "hurdle" to assess what might be going on when they could not rouse the patient. All the indications were that the cause of his unconsciousness was the opioid fentanyl, which had been administered as local pain relief at the very end of the operation. As the consultant expecting to take over Mr Gough's post-operative care in the adjacent post-anesthesia care unit, Dr Pandy said that without the handover he was relying on information that the patient had been given fentanyl. Therefore he and other medics administered drugs to counteract that. When this had not worked they could not understand the reasons, the hearing was told. Cardiff and Vale University Health Board contacted South Wales Police on October 11, 2022 "to report concerns" for patient Donald Gough, who had deteriorated after surgery. On November 5, 2022, South Wales Police was told by the health board that Mr Gough, 77, had died at UHW "after experiencing unexplained high levels of insulin in his system. The force launched a joint investigation with the health board to find out how Mr Gough had become unwell and what had led to his death, but it is still unclear. The Crown Prosecution Service was consulted throughout the investigation and prepared a file of evidence on behalf of the coroner. There is currently no ongoing criminal investigation. The hearing continues. Get daily breaking news updates on your phone by joining our WhatsApp community here . We occasionally treat members to special offers, promotions and ads from us and our partners. See our Privacy Notice