No inquest if your weight might have been a contributory factor in your death

This last week the sad and sorry saga with the Liverpool Area Coroner and the Medicines Health Regulatory Authority reached a new low point. My brother, Felix – who worked on the soap Hollyoaks for 20 years, tragically died of a heart attack at the age of 59 in March – just as the Covid 19 pandemic started to grip the UK. It was truly grim after the death. The press had a field day sensationalising the death when Lime Pictures announced the production closure of Hollyoaks, at the same time as his unexpected death – so people were misled into thinking Felix died of Covid – when in fact Felix’s death was an excess death from heart disease due to lack of care in the pandemic.

Because Felix was a bit overweight at the time of his death, there will be no inquest. This feels like such a slap in the face when he couldn’t actually exercise due to his illness.

Here is my brother’s voice from the grave, in a message sent to a close friend after taking his first dose of doxycyline, an antibiotic medication he was given when his cardiac illness was misdiagnosed as a chest infection – on March 16th. Felix died on March 20th:

I feel really rough but it’s all just unpleasant side effects from the antibiotics for my chest infection. I think the doctor gave me the strong stuff! ….Maybe (it’s Covid 19) but there’s so many possibilities. My attack was out of the blue- I was awake for a while and felt fine but once I got out of bed I started feeling really sweaty so I went back to bed and it swept over me like a slow wave and I could feel my arm muscles begin to ache and my chest felt heavier. My temp was 34 and I wasn’t comfortable standing up. It’s slowly gone back up to 35.3 and I now feel like I could walk around a bit but I still feel crap.

In a letter to my MP, Rt Hon Rachael Maskell, who kindly wrote on my behalf to the coroner – who has ceased communication with me since April, the coroner explains:

“The death has been ‘resolved’ according to the form 100B procedure.

The pathologist found that there was heart disease present which has resulted in Felix suffering an acute fatal heart attack. He stated there was no evidence of Felix having reacted to the anti-biotic medication and that Felix would have been more prone to suffering a cardiac event such as this due to him being overweight.”

I am at a loss to understand why the pathologist neglected to mention, in his final post mortem report, that there have been 61 ADRs -adverse cardiac reactions associated with the drug doxyxycline, and three fatalities (before my brother that is). Despite all these cardiac ADRs, the pathologist said in his report that he could “find no evidence in the literature for doxycycline being associated with causing or exacerbating ischeamic heart disease”. This information about ADRs is freely available to all, in the public domain, on the Medicines Health Regulatory Authority Yellow Card website in the Interactive Drug Analysis Profiles. The true number of ADRs may be far greater than this. The Yellow Card Scheme may have major issues with under reporting due to poor public awareness. The practice manager of my brother’s GP surgery had never heard of the scheme when I spoke with her – which I found pretty shocking given she had worked there for 20 years.

The problem in my brother’s case is the histological evidence didn’t match with my brother’s lived experience – which was shared with his friends and loved ones before he died. The dates didn’t match. The pathologist explained that “there was evidence of an old infarct and one recent infarct but non within the timeframe that would be linked to the prescribed doxycycline medication”. Despite the lack of histological evidence, we all knew that Felix said he experienced an awful reaction to the drug, and that he looked at the PIL (Patient Information Leaflet) that came with the medicine for answers. Instead of helping, he found a long list of side effects that left him totally confused into continuing with the medication ,when he should have called for emergency assistance – as anyone should do when they experience the above symptoms. Felix did try to call 111 – but he could not get through because the week of 16th of March saw the country and health service in chaos – it was the week before lockdown and all the attention was on Covid. It is puzzling also why a blood test my brother went for on the 18th March didn’t receive any consideration by the coroner or pathologist – and we have no idea why he even went for this blood test.

Unfortunately none of us knew the whole story or had the whole picture. So when Felix felt better on the 17th and 18th of March, went for his blood test, and called us to say he would soon be on the mend with the medicine (which he thought he needed) and some time off work resting, we were lulled into a false sense of security just as he was.

Does Felix not deserve an inquest because he was a bit overweight? Is this really why he died? At the same time as the British Heart Foundation is trying to dispel the myth of cardiac disease being something that affects middle aged overweight men the coroner seems to reach for easy answers and ignores the evidence from Felix’s family and those he spoke to in the days before his death. His voice just isn’t being heard. What we are saying doesn’t seem to count or have the same weight as the pathologist’s report. Surely this should all be given consideration?

It is incredibly saddening that the coroner doesn’t seem to think about the fact that Felix might have been carrying extra weight when he died because he hadn’t been able to exercise for the last two months as he liked to do. He felt breathless on any exertion. Felix was tired and lacked any energy – just managing to go to work and come home for the months before his death. Not used to being unwell he ploughed on regardless until he dropped – telling us all not to worry – and not taking time off to see a doctor until it was too late and none was available as the pandemic took hold.

From the perspective of his loved ones Felix died because he couldn’t see a doctor in the Covid pandemic to question him about his illness. From our perspective, it seems he may have died because he was misdiagnosed, and his pulmonary oedema from a failing heart was mistaken for a respiratory infection. For us, it seems far more probable that he died because he was a very poorly man given the wrong medication than his carrying a few extra pounds – given what he told us about taking the drug. And what is totally undeniable, and not given any consideration by the coroner or the MHRA, is the fact that Felix was completely misled by the information that came with the drug into believing he was experiencing side effects from it.

How many others will do the same?

Coroners will be overwhelmed in the pandemic I am sure and with a huge backlog of cases to go to court – so finding a ways to ‘resolve’ a death that means no inquest is needed will be very helpful to them and I doubt this will be the only case where the fact a person was a bit overweight, even when it is the result of the illness itself, means the death will not get the consideration it deserves.

RIP my lovely brother. Its how you lived that is important to those you left behind. The last six months have been awful for me as I battle to have something good come out of such a dreadful loss. I miss you so much – you kind gentle man. I am so sick of having to think about how and why you died, because those who should be thinking about it seem to close ranks and ignore what I am telling them – and make you into a statistic that is not worth them thinking about – another overweight man dying of cardiac arrest.