The doctor who prescribed the medication which led to the death of an 18-year-old boy has said she would do it again because she believed it was in “his best interests”.

Thomas Oliver McGowan, known as Oliver, was only 18 years old when he died in Southmead Hospital on November 11, 2016, following complications with his care.

The young man, who had mild autism, epilepsy and learning difficulties after suffering from meningitis at three weeks old, was taken to Southmead with simple partial seizures.

Doctors were told by Oliver and his parents not to give him anti-psychotic medication. They said he had developed an allergy to it and Oliver said it made him “feel terrible”.

But the anti-psychotic drug Olanzapine was given without his parents’ knowledge, Avon Coroners Court heard, and was stopped when his brain started swelling. It is commonly used to treat schizophrenia and bipolar disorder.

Olanzapine caused the teenager’s brain to swell when he developed Neuroleptic Malignant Syndrome (NMS), and he died because of his brain injury.

On the third day of the inquest, Dr Monica Mohan, the consultant neuropsychiatrist who prescribed the medicine, said she would still have done it because she believed it was in Oliver’s “best interests”.

“It was the best course for the young man, to have a better outcome,” she added.

What happened?

(Image: Family)

Oliver, from Emersons Green, was taken to Southmead Hospital on October 22 with a simple partial seizure. He was intubated shortly after to stabilise him.

Before he went under, he told medical staff twice he did not want anti-psychotic medication. After he was sedated his parents repeatedly told medical staff not to give him anti-psychotic medication because he had an “allergic reaction” to it before.

But they found out on October 26 he had started a course of Olanzapine the day before, and that it was prescribed by Dr Mohan.

Oliver had a reaction to it and his temperature rose to around 43C as he developed NMS because of the Olanzapine.

His brain swelled to the point it was “coming out of the base of his skull” and there was no chance of meaningful recovery. His life support machine was switched off on November 7, and Oliver breathed his last on November 11.

Did she know?

(Image: Family)

The court heard how the family had told Dr Mohan on several occasions on “no account” should Oliver be given anti-psychotic medication.

He had been put on it once in December the year before and taken off it quickly after when other doctors realised he had a reaction to it. He was discharged days after he was came off the drug.

A handover note from the specialist registrar in neurology Dr Luke Canham – the first neurologist to see Oliver in Southmead A&E – also said the boy was “intolerant to all anti-psychotic medication”.

Thomas McGowan, Oliver’s dad, told the court: “We reiterated to Dr Mohan, as we had to all medical staff dealing with Oliver since October 22 that on no account was anti-psychotic medication to be used.

“We made a point that this was Oliver’s and our explicit instruction”.

But Dr Mohan insisted they were in “best place to trial Olanzapine” because if Oliver had a reaction, he was already receiving care in ICU.

Representing the family, Anthony Metzer QC said it was her decision to prescribe the medication that resulted in Oliver’s death.

Dr Mohan said: “I went to see Oliver and I prescribed the medication Olanzapine so that he could have a better outcome and not go to a mental health unit.

“I had to do the best for Oliver at that given time because he was incapacitated and I wanted him to have a good outcome.

“I had to do that as a clinician. All the evidence I had heard pointed towards doing something reasonable, less restrictive, less detrimental, so he could have a better quality of life.”

‘I would do it again’

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Dr Mohan told the court Olanzapine worked quickly and she believed Oliver was in an emergency state because he was in ICU.

“Given the context he was in an emergency context, I needed something that would act quickly,” Dr Mohan said. “Olanzapine has an immediate effect.”

When asked if she would have done it again, knowing the family’s concerns and other doctors’ notes, she said: “I take responsibility because I wanted the best for Oliver.

“I prescribed it in the best interest and followed all the rules including consulting with the neurologist, Dr Campbell (ICU doctor) and the family.

“I took their concerns about Olanzapine, but I would choose it again because it’s one of the medications we use in an acute setting.”

However, Dr Mohan said the decision to prescribe the drug was a "multi-professional" one.

Mr McGowan said he believed Oliver would not have died if he had not been given the drug.

“We are driven to conclude that the doctors were arrogant and felt they knew best, and as a result, prescribed an anti-psychotic drug which Oliver and ourselves had expressly forbidden.”

‘I’m sorry’

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Dr Mohan had apologised to the family when they met in the staff restaurant days after a CT scan showed Oliver’s brain had swelled to the point there was no possibility of “meaningful recovery.”

A tearful and upset Dr Mohan told Mrs McGowan she was sorry.

“When I found out Olanzapine might have been a contributing factor for NMS, I did say I was sincerely sorry, because it was me who prescribed the medication,” Dr Mohan told the court.

When asked by the coroner if his parents told her not to prescribe the drug, Dr Mohan said: “If I had been told, I would have discussed it with them and explained them and probably come back to the same conversation that we need to use Olanzapine so we can help him get better.”

Mr McGowan told the court in his evidence: “We had sound reasoning for saying no to the administration of Olanzapine – Oliver’s previous reaction to the drug in December 2015 – but no matter how forcefully we relayed this to the doctors we were ignored.

“In the most tragic way possible, we believe we have been proven right.

“If Oliver had not been prescribed Olanzapine, we believe he would be alive today, enjoying college and having a productive life.”

The case continues.