Death of gifted student with anorexia ‘could have been avoided’, mother tells inquest
PUBLISHED: 18:20 28 September 2020 | UPDATED: 18:22 28 September 2020
The mother of a “beautiful and intelligent” teenager with anorexia, who penned a diary about her rapid weight loss while at university, has told an inquest her “tremendously courageous” daughter’s death could have been prevented.
Averil Hart, from Newton, near Sudbury, died just weeks into her creative writing course at the University of East Anglia in December 2012.
The former Colchester Royal Grammar School pupil, diagnosed with anorexia nervosa in 2008, had been a voluntary inpatient at Addenbrooke’s Hospital in Cambridge for 10 months before she left for university in Norwich in September 2012.
She was meant to be monitored closely by health organisations - but failed to have regular face-to-face check-ups and was found collapsed in her room by a cleaner in early December.
The 19-year-old was rushed to Norfolk and Norwich University Hospital (NNUH) – but it was three days before medics realised the seriousness of her illness.
She was transferred to Addenbrooke’s but was not seen by a doctor for several hours. The teenager died on December 15, after suffering a brain bleed, heart attack, and slipping into a hypoglycaemic coma.
Diary entries revealing how the 19-year-old felt exhausted and hungry in her first term at university were read to Monday’s hearing at Peterborough Town Hall.
In mid-November, she wrote: “I can’t believe I’m still going, what I’m even running on any more.
“I just look thin and in pain. It makes me so sad.”
Her mother, Miranda Campbell, said she felt the death of her daughter was “avoidable” – adding that the teenager bravely “fought every day to be free of the mental illness which was casting shadows over her life.”
In a statement read to the court by assistant Cambridgeshire coroner Sean Horstead, she raised concern at Averil’s assigned care coordinator Vikki Powell first seeing her three-and-a-half weeks after she started university.
She said the family had been told Averil’s discharge from hospital was where “the hard work really begins”.
The teenager was several kilos under her target weight, and considered to be at “high risk of relapse”.
Ms Campbell questioned why professionals had not raised the alarm over her daughter’s decline, adding that many of her consultations had taken place by phone.
A week after arriving, Averil wrote that she was “really loving uni” but was “letting the disorder get away with a lot”.
By mid-November, Averil wrote that she had lost several more kilos, admitting to falsifying her weight during weigh-ins.
“When I first arrived, I was swimming and running, today it hurts to go up the stairs,” she wrote.
The pain of losing Averil left a “gaping wound that never heals” and reduces her to tears every day, her mother added.
Her father Nic Hart told the inquest how he made an emergency call to NCEDS after a visit to Averil with her sister Imogen in late November to raise concern about her condition. By this time his youngest daughter was painfully thin and slurring her speech.
It had come as a surprise as his “incredibly intelligent” daughter was particularly good at putting on a brave face.
On December 7, she was found collapsed in her room by a cleaner and admitted to NNUH with a dangerously low temperature, blood sugar and blood pressure.
Mr Hart said: “On reflection, I should have camped outside the door and never left Averil’s side.
“I’ve been asked ‘Do you feel guilty about not taking your daughter to A&E and not intervening in that period’, and yes I do.”
He said that, while Averil was an inpatient for 10 months, she was weighed each morning under the same conditions, she had a meal plan and received treatment.
Mr Horstead asked Mr Hart what he expected Miss Hart’s monitoring and treatment regime to be after her discharge from hospital.
“My expectation was it would be different but equally robust,” he said.
The teenager’s mother described a phone call she received from Averil from the gastroenterology ward she was placed on at NNUH, with no specialist mental health support.
She was “panicky and breathless” after being asked to choose food from the hospital trolley, Ms Campbell said, adding: “I will never forget that fear in her voice.”
Doctors transferred her to Addenbrooke’s Hospital in Cambridge on December 11 - where her parents say a mental health assessment was ruled out by a consultant.
Mr Hart said this was despite Averil being “hardly (able to) lift her head from the pillow”, and “not being lucid” at times.
Averil died on December 15 and was “cradled by her family for every precious second” until she passed away, her mother said.
The inquest also heard from her boyfriend Alex Highfield, who described falling for Averil not only because of her “obvious beauty”, but also for her “incredible mind and rebellious streak”.
Mr Horstead is overseeing the separate inquests into the deaths of five women, including Averil, who died from eating disorders while under the care of Cambridgeshire and Peterborough NHS Foundation Trust.
Four of the inquests, into the deaths of Maria Jakes, Emma Brown, Madeleine Wallace and Amanda Bowles, have concluded.
All trusts involved in her care are represented in court and expected to give evidence later on.
The inquest, set to last four weeks, continues.
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