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Hospital did not fully recognise seriousness of anorexic teenager Averil Hart's condition, inquest hears

The hospital that treated an anorexic teenager after she collapsed at university has acknowledged it did not fully recognise the seriousness of her disorder and its contribution to her declining health.

Averil Hart, from Newton, near Sudbury , died at Addenbrooke’s Hospital in Cambridge on December 15, 2012, having fallen into a hypoglycaemic coma and suffering a brain bleed.

A week before, the 19-year-old was admitted to Norfolk and Norwich University Hospital (NNUH), after collapsing at the University of East Anglia (UEA).

Averil Hart.
Averil Hart.

This week, the inquest into her death heard that, upon admission, the creative writing student was treated for low blood sugar levels and declining liver function, but her rapid weight loss had not been immediately detected.

Dr Martin Phillips, consultant gastroenterologist at NNUH, said he was in communication with the Norfolk Community Eating Disorder Service (NCEDS), which Averil had been referred to while at UEA, following her discharge from an eating disorder unit in Cambridge.

But he admitted he had no formal training around eating disorders, and had only come across two other patients with anorexia in the nine years prior, neither of whom were as unwell as Averil.

“I recognised that she was seriously ill,” said Dr Phillips, who cared for the teenager on the weekend of December 8 and 9, 2012. “I don’t think I realised just how ill.

“At the time, I didn’t know many of the more detailed and nuanced aspects of dealing with anorexia.”

The inquest was told that Averil was given a nutrition plan, but did not immediately receive nasogastric feeding, due to concerns about refeeding syndrome – a serious condition that can occur when malnourished patients receive artificial feeding.

But assistant coroner Sean Horstead, overseeing the inquest, said records had indicated that Averil’s nutritional intake was not properly monitored by medical staff.

“There was no monitoring or food record,” said Mr Horstead. “A lot of it seemed to be self-reporting, rather than an objective record of what she was eating.

“The capacity to manipulate and change strategies, because of the disease-driven need to lose weight, would not have occurred to you.”

Dr Phillips acknowledged that his lack of experience with anorexia patients had made him unaware of these factors, but stated that during the period he treated Averil, he did not detect any serious deterioration that would have led to him to consult a specialist.

The inquest also heard that medics had focused on treating Averil’s liver damage, which had been diagnosed as potential accidental paracetamol poisoning, caused by the teenager taking medicine for “fresher’s flu”.

Questioned whether his specialism had led to an “elevated focus” on the liver injury and a lack of focus on the contribution her anorexia was having on her health, Dr Phillips replied: “I don’t think it was my seniority that influenced this.

“It was the clinical impression we all had. At that time, it was not well known that malnutrition could cause such severe liver injury.”

The inquest is expected to conclude next week.

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