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A coroner has written to the Health Secretary expressing concern after a mentally ill woman died following NHS electric shock therapy given without her consent.

The extreme treatment, first used in European asylums in the 1930s, was employed on Elsie Tindle, 71, who suffered a permanent epileptic seizure causing irreparable brain damage.

The treatment was given without her consent and without the second opinion from an appointed doctor required by law. Elsie's brain was completely starved of oxygen during the prolonged fit last year, a jury at Sunderland Coroner's Court was told.

The jury ruled that she died as a result of a "rare complication following the lawful and necessary administration of electroconvulsive therapy (ECT)".

The hearing, before Sunderland Senior Coroner Derek Winter, heard that ECT was decided upon by medics as 'a last resort' as Sunderland Royal Hospital was unable to manage Miss Tindle's mental health problems.

She had first been admitted to the hospital after a fall in November 2014, and she also suffered from depression and a learning disability. ECT shocks the brain under general anaesthetic with muscle relaxant medication to minimise the risk of broken bones.

(Image: Getty)

The inquest heard that, in order to perform ECG on a patient lacking the capacity to consent to it, a second opinion appointed doctor (SOAD) provided by the Care Quality Commission (CQC) must approve it.

An application for an SOAD was submitted on February 23, 2015, by psychiatrist Dr Eugene van Rheede van Oudtshoorn. No SOAD had been appointed by the time Miss Tindle went for ECT, carried out by the NHS Electroconvulsive Therapy Service at the Queen Elizabeth Hospital, Gateshead.

She had three treatments without an SOAD in place after an administrative error. Mr Winter will send a Regulation 28 report - which coroners have the power to issue in an effort to prevent future deaths - which he intends to send to the Secretary of State for Health Jeremy Hunt .

He said: "My concern is in the request and allocation of second opinion doctors in a timely way.

"This court heard that 82 per cent of SOADs are appointed within five working days of a request, but that begs the question about the services provided to the others."

While in hospital, Miss Tindle had been missing her sister Joan, and refused to take medication or food and would rip out her intravenous line.

(Image: Newcastle Chronicle)

She was considered a danger to herself and was detained under Section 3 of the Mental Health Act, which allows for up to six months' hospital treatment.

Dr van Rheede told the hearing: "She had three treatments without an SOAD in place.

"With Elsie, we had seen a downward cycle in her health. There would have been consequences in not taking action and there was an ongoing deterioration.

"We have to make a calculated decision of the benefits of taking the opportunity now, before the situation becomes difficult or impossible, and that was the right time."

The jury heard how one electrical impulse, which lasts a few milliseconds, is administered by two probes at each session, and aims to initiate a 30-second seizure.

Six treatments will put 40 per cent of patients into remission. Ten treatments work in 70 per cent of cases. Miss Tindle had three sessions of ECT on February 27, March 6 and March 10, returning to Sunderland after each one.

Although the third session appeared to have gone as planned, she fell ill the following day. She was taken to the high-dependency unit, and died in hospital 25 days later, on April 4, 2015.

Dr van Rheede added: "It's a very, very rare complication. I couldn't find other cases where someone had gone into a seizure or status epileptica a day later. There are anecdotal reports of people developing epilepsy after ECT, perhaps one in 80,000."

Home Office pathologist Dr Nigel Cooper, who performed the post-mortem on Miss Tindle, concluded the formal cause of death as anoxic-ischemic brain damage, due to status epilepticus, due to electroconvulsive therapy.

The Care Quality Commission has a panel of doctors trained and experienced in providing second opinions under the Mental Health Act. But many doctors do this part-time alongside their other work, and are not available at all times. A spokesman said: "We try to provide a Second Opinion Appointed Doctor to a patient detained under the Mental Health Act 1983 within five days of receiving the request. Last year we achieved this approximately 82 per cent of the time.

"Patients requiring more immediate attention can be treated without the presence of a Second Opinion Appointed Doctor under section 62 of the Mental Health Act, which ensures people are treated quickly in an emergency.

"We note the coroner's report and the circumstances in this case. We will consider the findings in detail and we will respond accordingly." Miss Tindle's family declined to comment on Friday.