Woman died with no specialist eating disorder help

Caris Graham is sitting on a horse which has two rosettes hanging from its bridle. The horse is brown with a white patch along its nose. Ms Graham is holding a mobile phone in one hand and the bridle with the other. She is wearing an orange t-shirt and a black protective vest and riding helmet.Image source, Family handout
Image caption,

Caris Graham studied equine care at college

  • Published

The family of a woman with a complex eating disorder said they felt "desperate for professionals to do something", following an inquest into her death.

Caris Graham, 22, of Brampton, Cumbria, died of organ failure after months of resisting foods and fluids while a patient at the Cumberland Infirmary in Carlisle.

Cockermouth Coroner's Court heard last week that a Serious Incident Investigation by North Cumbria Integrated Care trust (NCIC), identified the delay in transfer to a specialist eating disorder unit and that there was no clear escalation process.

The trust said Ms Graham's case was challenging and "sadly, the ideal, safe alternative placement did not exist at the time".

Ms Graham was autistic and had severe anxiety and depression at school and later at college when studying equine care, her family's solicitors said.

She was diagnosed with Avoidant Restrictive Food Intake Disorder, which meant she refused most food and fluids, leading to several hospital admissions.

'Too long in hospital'

The jury at her inquest recorded a narrative verdict, highlighting that the hospital ward had been "ill-equipped" to deal with the extremely complex nature of her needs.

It was also concluded that the length of time she spent on the ward was inappropriate, and that "escalation at a senior management level was ineffective", the solicitors said.

In a statement NCIC said it had "found it difficult" to manage Ms Graham's complex needs, despite the "best efforts" of staff.

A spokesman added: "We accept the findings of the jury and will ensure that the learning from Caris' care informs continuous improvements going forward."

If you are affected by any of the issues raised, support is available through BBC Action Line.

In February 2022, Ms Graham began a nine-month stay at Cumberland Infirmary where she was detained under the Mental Health Act, after being unresponsive.

Her family said she continued to resist food and fluids.

She was briefly discharged to her parents' home with an "extensive community care package", but days later she returned to hospital after suffering seizures.

She was transferred to the Intensive Treatment Unit (ITU) with malnutrition and a chest infection on 6 February 2023 and died four days later.

'Breaking point'

The inquest heard that Ms Graham had been cared for by "an extensive range" of specialists during her hospital stay.

In August 2022 she was referred to a specialist eating disorder unit, however she was not transferred due to concerns she may go into complete food refusal, as the unit required patients to comply with strict feeding and monitoring.

Ms Graham's mother, Helen, said her daughter had become "desperate" as she deteriorated and "it was frightening to watch".

"As a family we reached breaking point as we felt totally and utterly helpless and desperate for professionals to do something for her," she said.

She added that the family's GP had contacted facilities around the country, but "everybody said she was not suitable".

She said: "The light has gone out of our lives."

'Would have survived'

Family representative, Iftikhar Manzoor, of Hudgell Solicitors, said that had Ms Graham been transferred to a specialist unit sooner, she "would still be alive".

He said Ms Graham's physical condition became unstable from June 2022 and she was "often uncompliant" with her treatment, but a space at a specialist unit was available for her.

"Had she been transferred to a specialist unit sooner, before significant deterioration in her physical condition, then it is likely she would have survived," he said.

"It was not until January and February 2023 that substantial progress was made in arranging the transfer for Caris, but by this time it was too late."

Hudgell Solicitors said the family was considering civil legal action.

The family added: "Caris was let down by those entrusted to care for her.

"We feel that if Caris had received the care she needed and deserved a lot sooner, then she would still be here with us today."

An NCIC spokesman said the trust was "working closely" with Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.

He added: "We are working together to oversee complex cases at a senior level so that we can develop joint plans that meet both physical and mental health needs.

"Processes are in place to help staff to escalate concerns and ensure appropriate action is taken at a senior level."

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