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Clozapine Induced Constipation & failure to follow the Mental Capacity Act

An inquest is being held into the death of a man named as John Warren, that was judged to lack the mental capacity to consent to a gastroscopy. The man was detained under Section 3 of the Mental Health Act. One of the causes of death was an intestinal obstruction due to clozapine induced constipation. Part of the reasons appears to be a failure to follow the best interests process under the Mental Capacity Act. John had repeatedly attended A&E with concerning symptoms such as '...dark and loose stools, with scans showing faecal impaction, which was having a severe effect on his respiratory system.'

This news article explains that '...John attended Wythenshawe hospital for the gastroscopy procedure on December 17, however, the doctor decided that he [John] did not understand the procedure enough, and therefore could not consent to it. The procedure did not take place and he returned to the Priory. Dr Geeta Prasad, a consultant Gastroenterologist at Wythenshawe hospital, made this decision, telling the jury she felt John was “unable to consent to the procedure”. Dr Prasad also didn’t believe the surgery was an emergency but wrote an ‘urgent letter’ to the Priory to discuss if the procedure was still in his ‘best interest’ and could be done if he did not have the capability to consent himself. A reply did not come from this letter, however.'

He attended A&E for the final time on 29th December and was pronounced dead at 11am on 30th December 2020.

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