Teresa Scheunert probably died from the combined toxic effects of opioid painkillers and other medications, according to the toxicologist who analyzed her blood.
The inquest into Scheunert’s death began on Monday in Whitehorse. The registered nurse died in Watson Lake hospital on June 21, 2012, about two weeks after being admitted for management of severe back pain.
Walter Martz wrote the toxicology report following Scheunert’s unexpected death. He found amounts of two opioid drugs and two other medications that, taken alone, would not point to a drug overdose.
But in combination the drugs, all of which have sedative effects, could point to a cause of death, Martz told the inquest jury on Thursday.
Scheunert was prescribed a variety of painkillers during her stay at the Watson Lake hospital. Her doctor, Tanis Secerbegovic, called the admission a “roller coaster” because of the difficulty in finding a combination of medications that would manage Scheunert’s pain and changing symptoms.
Martz told the inquest to pay close attention to the many mentions of “snoring” in the nurses’ notes on the morning that Scheunert was found dead.
That, in his experience, is a common observation when drug addicts die of an overdose, he said. Roommates will say they thought he was fine because he was snoring, and then he is found dead.
Snoring may be a sign of respiratory distress, but it was also something that Scheunert did normally while sleeping, as all the medical staff in Watson Lake attested in their testimony.
But Martz asserted that snoring was noted more frequently on that morning than on other days, and that could be an indication that it was out of the ordinary.
The drugs in her system, in combination, could be enough to depress her respiratory system until she stopped breathing, he said.
But many questions remain unanswered.
The toxicology report found oxycodone in Scheunert’s blood in levels not easily explained by the records of medications administered to her while in hospital.
Scheunert had filled prescriptions of oxycodone before being admitted to the hospital, so it is possible but by no means proven that she may have taken some from her own supply. Scheunert frequently spent time at home during the day.
Dr. Thomas Perry, an internal medicine specialist based in Vancouver, testified that mixed drug toxicity may be an obvious answer as to how Scheunert died, but that doesn’t mean it’s the right one.
There are a lot of factors that could have contributed to the death, he said.
He posited that sleep apnea, a sudden heart failure or a spinal infection all could explain the death, and there is simply not enough data to know for sure.
Certainly there are many gaps in the documentation of Scheunert’s case.
Dr. Secerbegovic made no notes to Scheunert’s file between the day of her admission and the day of her death, although orders were relayed to nurses who recorded them.
Secerbegovic testified that she was the only doctor working in Watson Lake most days at that time, and non-urgent paperwork took a back seat to patient care.
Dr. Said Secerbegovic, Tanis’s father, made notes of interactions with Scheunert days after they occurred. This was normal practice when things were busy, he testified.
The nurses’ notes and medication records provide an incomplete picture of what happened during Scheunert’s stay in hospital. Documents are difficult to interpret, even by the medical staff who penned them, and contain significant recording errors.
While Dr. Tanis Secerbegovic ordered that Scheunert’s vital signs be taken four times per day, they were taken less than once per day on average. They were not taken in the last 48 hours of Scheunert’s life.
A hospital policy to not leave medications by a patient’s bedside without a doctor’s order was not followed.
Neither was a policy that required specific documentation of the application and disposal of patches containing fentanyl, a potent opioid drug that was administered to Scheunert.
Samples from Scheunert’s stomach contents were collected during the autopsy but not analyzed in the toxicology report. Those results could have given a clue as to where the oxycodone found in her blood after death came from.
The autopsy also did not examine Scheunert’s back and spine, even though that area was her main source of complaint.
The inquest into Scheunert’s death continues today at the courthouse in Whitehorse. The jury of six must decide what caused her death, and may make recommendations to prevent similar deaths in the future.
Contact Jacqueline Ronson at