The family of a young woman who had a severe eating disorder and died of organ failure after months of resisting foods and fluids in hospital say she would still be alive today – with ‘so much to look forward to’ – had she been admitted to a specialist unit.
Caris Graham, 22, of Brampton, Cumbria, was autistic and battled with severe anxiety and depression throughout her school years, and later at college when studying equine care.
She had Avoidant Restrictive Food Intake Disorder, a condition which led to her refusing most food and fluids, and contributed to her being admitted to hospital on numerous occasions due to nutrition issues.
In February 2022, following a decline in health, she was admitted to Carlisle Infirmary and detained under the Mental Health Act due to being catatonic and unresponsive.
She remained in the hospital for nine months, during which time she continued to often resist the necessary food and fluids.
She was briefly discharged to her parents’ home with an extensive community care package, but just days later her family had to call an ambulance as she was having seizures.
Caris was found to be suffering from dehydration and malnutrition and had a chest infection. She was transferred to the Intensive Treatment Unit (ITU) on February 6th, 2023, where she died four days later of organ failure.
Caris’ mother, Helen, said it had been ‘frightening’ to see her daughter’s health deteriorate so badly over the years and witness her become ‘desperate’ as they could not access suitable, specialised help. She said:
During her time at secondary school it was noticeable that she had issues and she struggled in the larger classes. She was diagnosed with social anxiety and the eating disorder.
Our local GP tried a few facilities around the country to help with her complex needs but everybody said she was not suitable.
When she had her first catatonic episode, we had never experienced anything like it. She was terrified of everything and everyone. It was frightening to watch her, feeling helpless and not knowing how to help.
She became desperate and on occasions took overdoses. As a family we reached breaking point as we felt totally and utterly helpless and desperate for professionals to do something for her.
Words can’t describe the loss we feel having to say goodbye to our baby girl. The light has gone out of our lives.
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Two referrals made to specialist eating disorder unit
Caris was first assessed by a mental health specialist at the age of 16, and during her time in Carlisle Infirmary in 2022, she was assessed and cared for by an extensive range of specialist health professionals.
In August 2022 she was referred to a specialist eating disorder unit (SEDU), where she could have been cared for by people with experience and expertise in treating patients with eating disorders.
However, she was not transferred due to concerns that she may go into complete food refusal, due to the requirement to comply with strict feeding and monitoring requirements on the unit.
With her health continuing to decline, she was once again referred in January 2023, when it was concluded that admission was the most appropriate treatment route, provided her physical health improved.
However, she continued refusing to accept nutritional intake, and having become unresponsive again she was admitted to the Intensive Treatment Unit at the hospital with liver failure.
She remained sedated and intubated in the unit until she died from multi-organ failure on February 10th.
Solicitors say there was ‘clear delay in escalating care’
An inquest at Cumbria Coroner’s Court this week heard that a Serious Incident Investigation at the Trust identified the delay in transfer to a specialist eating disorder unit, and no clear escalation process of the case, as ‘key findings’.
The jury recorded a narrative verdict, highlighting that the hospital ward had been ‘ill-equipped’ to deal with the extremely complex nature of Caris’ medical, behavioural and psychological 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’, with a long-term solution for her care needs never found. The family were represented by Iftikhar Manzoor and Soraya Mehdizadeh of Hudgell Solicitors.
Mr Manzoor said:
There were extended periods when Caris did not receive adequate nourishment and basic medical attention.
She was in a dependent position and her need for adequate nourishment and basic medical attention was obvious. However, the ward she was on at Carlisle Infirmary was unable to provide the care that she needed.
Throughout the relevant period there was a specialist eating disorder unit where specialist staff and treatment facilities were better placed to treat Caris.
From around June 2022 Caris’ was often uncompliant with her treatment and care and over time, her physical condition became unstable. Had she been transferred to a specialist unit sooner, before significant deterioration in her physical condition, then it is likely she would have survived.
It was not until January and February 2023 that substantial progress made in arranging the transfer for Caris, but by this time it was too late.
There was a clear delay in escalating the case to ensure that appropriate steps were taken to provide Caris with adequate nourishment and basic medical care.
Hudgell Solicitors are now advising Caris’ family over potential civil legal action.
‘A unique soul who will be missed every day’
In a statement after the Inquest, her family said:
We feel this inquest has highlighted the unclear and inconsistent treatment Caris received.
She was a much-loved daughter, sister and auntie and the tragic circumstances of her death have caused devastating heartbreak for our family.
We cannot express the hurt and anguish we feel. 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.
We will forever remember her as a unique soul who loved to laugh and to make people laugh. Growing up, she loved going on adventures and days out, and she was a practical joker and loved playing pranks on people.
She loved to have a laugh with people and could always boost your spirits with her energy. She had so much to look forward to in life but will now never get the chance.
We miss Caris so much and will continue to miss her every day for the rest of our lives.
