The UK Health Security Agency (UKHSA) has explained its role in investigating the case of a woman who died following an E. coli infection after being criticized in a coroner’s report.
An inquest concluded that Laura Farmer died of a stroke caused by an E. coli infection.
After an illness with diarrhea about ten days earlier, the 46-year-old was admitted to University College Hospital in April 2024. She was diagnosed with hemolytic uremic syndrome (HUS), caused by Shiga toxin-producing E. coli (STEC). When she thought she was in the recovery phase, she suffered an unexpected stroke and died.
Coroner Mary Hassell said UKHSA had not been called to give evidence at the inquest because she would have expected the agency to have shared relevant information with doctors and the family.
“During the investigation, the evidence identified matters of concern. In my opinion, there is a risk that deaths will occur in the future unless action is taken. After the death from E. coli, there appears to have been no closing of the loop on safety information that could have helped those most affected,” she said.
UKHSA’s role in the investigation
Hassell said Laura Farmer and her family found her E. coli infection difficult to understand. She was a vegan who took great care in food preparation. As a family they were extremely hygiene conscious, especially as one of them has a nut allergy.
UKHSA said that because its officials were not contacted, all relevant evidence was not taken into account in the coroner’s Prevention of Future Deaths report.
The coroner said UKHSA did not ask Laura’s husband Steve for any information that could help find the source of the E. coli infection. When asked, Steve allegedly explained that one day in April 2024, they had visited a local restaurant, had drinks at a nearby club and recently had dinner and drinks at local military facilities.
On April 25, Laura Farmer was interviewed by UKHSA South East about her condition while in intensive care. She was asked about details about contact with water and animals, eating out and people with gastrointestinal infections. Laura wasn’t sure about five details, so she asked the agency to send her an email so she could contact her husband.
A day later, UKHSA South East called to ask if she had obtained the additional information, but was unable to make contact. On April 29, after further failed attempts, UKHSA South East was informed that Laura had died.
UKHSA South East agreed that no further contact should be made. UKHSA South East believed the family was in mourning. The decision not to speak to the next of kin was made on the basis that public health actions had been completed, the risk of ongoing transmission within the household was extremely low, contacts with both households were good at the time of the interview and a significant Time had passed since the onset of Laura Farmer’s illness.
Respect for privacy versus need for information
Steve Farmer saw an E. coli outbreak in Waverley, Surrey. Doctors at University College London Hospital knew which strain of E. coli had infected Laura, but not whether it had been discovered in Waverley or elsewhere. After reporting to the UKHSA they were given no feedback, no advice on infection control and no information to give to Steve.
The STEC subtype that caused Laura’s illness was E. coli O26:H11. Three other cases were microbiologically linked using WGS. UKHSA has reviewed the information on these four cases but has found no common link between these cases nor a likely source of infection.
Around 1,500 cases of STEC are reported in England each year, with between 250 and 450 clusters detected, the majority of which are small, with five cases or fewer. UKHSA said it is often not possible to identify the source of infection for individuals, and investigations can be lengthy and complex.
According to the coroner’s report, Steve Farmer had spent considerable time and effort obtaining basic information from public health authorities since his wife’s death, but without success. He found it incredibly difficult to find the right person to talk to and equally difficult to gain any meaningful understanding of what had happened.
Hassell said this failed to build public confidence and seemed like a very clumsy way to deal with a grieving family member.
In mid-June, a senior doctor from UKHSA South East called Steve Farmer after asking for more information about his wife’s illness. He said that after Laura’s death he became unwell with diarrhea. He was told that Laura’s illness was not related to any outbreaks of STEC.
An informal peer review by UKHSA South East identified one learning point in relation to dealing with accidents. When a person dies during an investigation, a risk assessment should be carried out with the clinical team handling the case to determine whether additional contact should be made with next of kin. The privacy of a grieving family must be balanced against the potential need for information.
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