· Officer left lying in coma on floor of her cabin
· Naval doctor failed to spot symptoms of diabetes
The Royal Navy was criticised by an inquest jury yesterday over the death of a lieutenant left lying in a coma on the floor of her cabin because shipmates thought she must be drunk.
Emma Douglas, 29, was seen collapsed on the floor, undressed from the waist down, but a rating shut the door and left her there, though she was not known to be a heavy drinker.
A navy doctor who saw Douglas four days earlier had failed to spot her symptoms of diabetes, and had thought that her constant vomiting was seasickness.
A postmortem examination showed that she had lost four stones in weight in the two months before her death, and doctors said her life could have been saved if she had been treated appropriately.
The inquest in Plymouth criticised the navy for missing opportunities to save her life.
The Plymouth coroner, Ian Arrow, is sending the jury's findings to the General Medical Council and the navy so they can consider disciplinary action.
Douglas's family are suing the Ministry of Defence and are considering appealing to the high court because they believe the coroner was wrong to rule that the jurors could not return a verdict of unlawful killing.
Her mother, Cynthia, said: "Sadly, we shall always believe she was badly let down by her naval colleagues. No one has accepted any responsibility or been held in any way accountable for Emma's death.
"This is something our family have found very disappointing."
The inquest heard that Douglas became ill with a stomach infection caused by an unclean ice cube while her frigate, HMS Cornwall, was on a goodwill visit to St Petersburg.
The infection may have hastened the onset of the diabetes which killed her but which was never diagnosed.
Four days before her death, she told a naval doctor she was worried about her health. She was diagnosed as having oral thrush by Surgeon Commander Marcus Evershed. He did not carry out a urine test, which would have revealed diabetes.
Douglas was declared fit for duty but advised to rest in her cabin, where she was seen naked from the waist down and gurgling by Petty Officer Gary Shuttlewood on the day before she died.
He reported it to Warrant Officer David Carter but he took no action because he believed she was sleeping.
A police inquiry found that Douglas had not been helped because she was thought to have been drunk.
Officers denied this at the inquest. They said it was common knowledge on board that she slept on the floor because she had a bad back, and so it was assumed she was resting.
Crown prosecutors in Devon recommended charging the navy or its staff with manslaughter due to gross negligence but a senior official in London decided there was not enough evidence to take the case to court.
The jury in Plymouth returned a narrative verdict in which it spelled out how Douglas had died from diabetic ketoacidosis, which can lead to confusion, coma and death.
On her being left, the jurors said: "Procedures would appear not to have been followed. Given the unusualness of her state of undress and the fact she was on the floor with noisy breathing, this should have triggered a greater response.
"The only action taken was to return and close the cabin door. This action was inappropriate as it conveyed to subsequent personnel she did not wish to be disturbed."
Douglas's mother added: "Emma achieved and accomplished more in her short life than I ever expected her to and made me extremely proud to be her mother.
"Emma was a vivacious young woman who loved life to the full. She was a truly wonderful human being. We all miss her terribly and think of her every day.
"We hope the evidence at this inquest and the findings of the jury will enable the Royal Navy to review its procedures to ensure nobody else loses their life in similar circumstances."
A navy spokesman said that lessons had been learned and procedures tightened.
Basic common sense would have been1. Get multiple persons to help.
2. Cover the Lieut. up down below.
3. Check to see if she had a pulse.
4. Revive the Lieut. if necessary.
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