Jacobs had a number of conditions, including Turner syndrome, a chromosome deficiency, along with the intellectual disability that sometimes accompanies it.<\/p>\n
Although able to ride her bike to the shops, she was dependent on her carers, had limited speech and little ability to advocate for herself. <\/p>\n
She received treatment for asthma, suffered from hypertension and had an enlarged thyroid, or goitre.<\/p>\n
She had also been nagged by a persistent, habitual cough for more than 20 years. The only times she would not cough were when she was eating or sleeping. <\/p>\n
Jacobs had been in residential care since 1994, apart from when she lived with her younger sister Stephanie Salisbury\u2019s family during the Covid pandemic. <\/p>\n
However, she would go to Salisbury\u2019s home every second weekend and attended wider family occasions.<\/p>\n
\u201cShe was very much loved and a big part of our family,\u201d Salisbury said. <\/p>\n
In the weeks before her death, Salisbury felt her sister\u2019s health was deteriorating and it got to the point where Jacobs could not move without coughing. She struggled to breathe while eating.<\/p>\n
Debra Shirley Jacobs died suddenly in 2023. Photo \/ Supplied<\/p>\n
At Salisbury\u2019s request, staff at Idea Services, which ran the home where Jacobs lived, tried twice to change her doctor to get a second opinion about her health. <\/p>\n
They were unsuccessful, as the medical practices were full and not taking on new clients.<\/p>\n
After her sister died, Salisbury said she was \u201cvery distressed\u201d to receive her sister\u2019s phone and find on it messages that Jacobs had been trying to send to family members and her doctor in the days and weeks before she died, seeking help.<\/p>\n
The messages were not sent because Jacobs did not have any credit on her device.<\/p>\n
\u201cIt was heartbreaking to read those messages and know that Debra was trying to contact us for help and she would have been wondering why we did not come,\u201d Salisbury said in evidence to the coroner.<\/p>\n
Salisbury also found three short videos on her phone: one possibly recorded accidentally in which Jacobs is coughing; one in which she is heard to say \u201cOh, God, my throat\u201d and coughs while talking to her cat; and a third in which she is out of breath and wheezing while sitting in one spot.<\/p>\n
The videos were played to the inquest and two doctors who provided care to Jacobs were asked about a particular type of cough that was captured on the soundtrack. <\/p>\n
An inquest hearing into the death of Debra Jacobs was held at the Hastings courthouse.<\/p>\n
The cough was identified at the hearing as stridor \u2013 a noisy wheeze that can indicate the airway is obstructed, putting the patient in danger.<\/p>\n
Jacobs\u2019 long-term GP, Richard Eastcott, now retired, was asked what he would have done had he heard her stridor in real life.<\/p>\n
\u201cIf I had heard that, I would have sent Debra to hospital,\u201d he said.<\/p>\n
Another doctor, Rachael Harris, who at that time worked in Eastcott\u2019s practice and who saw Jacobs in the fortnight before she died, was also asked about the stridor on the video. <\/p>\n
She said that if she had heard stridor in a consultation, she would have \u201ccalled for assistance, or called 111\u201d.<\/p>\n
Harris saw Jacobs when she was taken to the medical practice on September 4, 2023, 10 days before she died.<\/p>\n
In that consultation, no wheeze was heard when Jacobs\u2019 chest was examined. <\/p>\n
A summary of the consultation provided to the inquest by Eastcott said Harris gained the impression of \u201ca post-viral cough and post-nasal drip, [and] early lower respiratory tract infection\u201d. A nasal spray and antibiotics were prescribed.<\/p>\n
No post-mortem exam conducted<\/p>\n
After Jacobs died, no post-mortem examination was conducted and Eastcott signed off her death certificate.<\/p>\n
Salisbury, as Jacobs\u2019 next of kin, raised questions about this with the coroner.<\/p>\n
\u201cNone of us could understand why there wasn\u2019t an autopsy and I had no answers for people or myself,\u201d she said.<\/p>\n
Coroner Ian Telford held an inquest into Debra Jacobs’ death. Photo \/ Supplied<\/p>\n
\u201cDr Eastcott had told me there was no explanation for why Debra died and he did not understand how or why it happened, so how could he be sure what really killed Debra?\u201d<\/p>\n
Eastcott told the inquest that after Jacobs died, he was contacted by Napier police, who asked if he was able to sign a death certificate. <\/p>\n
He declined to do so, because he was not the doctor who had seen Jacobs last, because her death was sudden and unexpected, and because he had not seen her for three months.<\/p>\n
The police then referred the death to the coroner, and the following day, Eastcott was contacted by one of the coroner\u2019s clinical advisers.<\/p>\n
The clinical adviser told him Jacobs was \u201cunlikely to reach the threshold\u201d at which a post-mortem examination would be carried out.<\/p>\n
Eastcott and the adviser discussed what they considered the most likely cause of death \u2013 a chest infection against her background of Turner syndrome and asthma. <\/p>\n
\u201cFrom my review of the clinical records a lower respiratory tract infection seemed to be the most likely cause of death,\u201d Eastcott said.<\/p>\n
\u201cI was advised that I could sign a medical certificate of causes of death for Debra on this basis, and if her family agreed to a death certificate being completed, with a cause of death being made on the strength of probability,\u201d Eastcott said.<\/p>\n
He said he would have preferred it if an autopsy had been performed but he was guided by the advice he had received on the phone from the clinical adviser.<\/p>\n
\u201c[It was] a most unusual phone call,\u201d Eastcott told the coroner.<\/p>\n
\u201cIt has never happened in the 40 years I have been qualified. It sticks in my mind.\u201d<\/p>\n
Sister not listed as next of kin<\/p>\n
Eastcott needed the agreement of the family to sign the death certificate, but Salisbury was not listed in his records as being Jacobs\u2019 next of kin. <\/p>\n
When Eastcott\u2019s practice was restructured into a new legal entity some years ago, patients were required to fill in new registration forms, and Salisbury\u2019s name was omitted.<\/p>\n
Eastcott therefore got consent to sign the medical certificate from another sibling whose phone number he had, because he was also a patient.<\/p>\n
Because no autopsy was carried out, Jacobs\u2019 exact cause of death remains unknown.<\/p>\n
Independent opinion called in<\/p>\n
Coroner Telford asked another doctor, Johan Peters, to look at the case and provide a report.<\/p>\n
Peters\u2019 report warns that his opinion is \u201cspeculative\u201d, but he draws attention to Jacobs\u2019 goitre, or enlarged thyroid, possibly causing an upper airway obstruction.<\/p>\n
Dr Johan Peters provided a report to the coroner. Photo \/ Gisborne Herald<\/p>\n
\u201cI consider this the most likely cause of death, on the basis of a known goitre, not further assessed or treated for years, with persisting and steadily increasing cough, causing disturbance at night, not addressed by treatment for asthma,\u201d Peters said.<\/p>\n
\u201cThe probable presence of stridor as heard in the video evidence is highly suggestive.\u201d<\/p>\n
Peters said that lying down or sleeping would cause a relaxation of the upper airway, completely obstructing air passages critically narrowed by an enlarged goitre.<\/p>\n
\u201cDeath then is rapid due to hypoxia [lack of oxygen], explaining the lack of signs of distress when found.\u201d<\/p>\n
Jacobs\u2019 body shape, common with people with Turner syndrome, heavy-set with a wide neck, would have made monitoring the progress of the goitre difficult, the hearing was told. <\/p>\n
Coroner Telford\u2019s inquest findings will be published at a later date.<\/p>\n
Ric Stevens spent many years working for the former New Zealand Press Association news agency, including as a political reporter at Parliament, before holding senior positions at various daily newspapers. He joined NZME\u2019s Open Justice team in 2022 and is based in Hawke\u2019s Bay. <\/p>\n","protected":false},"excerpt":{"rendered":"Jacobs had a number of conditions, including Turner syndrome, a chromosome deficiency, along with the intellectual disability that…\n","protected":false},"author":2,"featured_media":328531,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[3595,12629,634,61423,42,35200,117157,3607,43,1118,24994,40,38,41,39,1354],"class_list":["post-328530","post","type-post","status-publish","format-standard","has-post-thumbnail","category-headlines","tag-by","tag-coroner","tag-death","tag-debra","tag-headlines","tag-investigated","tag-jacobs","tag-napier","tag-news","tag-of","tag-sudden","tag-top-news","tag-top-stories","tag-topnews","tag-topstories","tag-woman"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/328530","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=328530"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/328530\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/328531"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=328530"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=328530"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=328530"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}