Concerns raised over emergency staff awareness of eating disorder guidance following coroner’s inquest into Karen Graham’s death

A Cheshire coroner has highlighted a potential gap in emergency department protocols for assessing patients with eating disorders, urging the Royal College of Emergency Medicine to address awareness issues after the tragic death of Karen Graham, who lived with anorexia nervosa.

A Cheshire coroner has warned that emergency department staff may be missing guidance meant to help them assess people with eating disorders when they arrive acutely unwell, after concluding an inquest into the death of Karen Graham. Victoria Davies, the area coroner, said the concern centred on a lack of awareness of the Medical Emergencies in Eating Disorders, or MEED, guidance among clinicians in acute care, and wrote to the Royal College of Emergency Medicine to ask what action it will take. The college has 56 days to respond.

Graham, 54, had lived with anorexia nervosa for many years and was under the care of an eating disorder team. The coroner said her body mass index had been chronically low and varied over time. In January 2026, clinicians noted that she had lost a significant amount of weight compared with a weigh-in earlier that month, although she reported no physical symptoms. A follow-up review and possible admission to an eating disorder unit had been planned for 19 January, but she was found dead at home on 17 January.

The inquest also examined an emergency department visit in November 2025, when Graham attended Leighton Hospital feeling weak. She was discharged after checks showed no immediate concerns beyond low blood pressure and a low BMI that were already known to clinicians. An ECG, used to look for heart rhythm problems that can occur in people with poor nutrition or electrolyte imbalance, was normal. The coroner said Graham was not weighed and the mental health team was not involved because she declined discussion. Davies found that, at the time, emergency staff did not know the MEED guidance existed.

Davies said she thought awareness of the guidance would probably have prompted weighing Graham, or at least an offer to do so, and a discussion with liaison psychiatry and her eating disorder consultant. She did not find that this would have led to admission on that day, but said it might have triggered closer physical monitoring in the following days. The coroner concluded that there were no failings in Graham’s care that caused her death, which was attributed to natural causes from anorexia nervosa.

In her report, Davies said the concern was not limited to Leighton Hospital. She pointed to earlier prevention of future death reports, including one in the case of Nichola Lomax and another touching the death of Averil Hart, as evidence that the issue had surfaced before. She also noted that Leighton Hospital has since created a local guideline based on MEED and placed it on its intranet, making it easier for staff to find. Even so, she said she remained concerned that broader action was needed, and that the Royal College of Emergency Medicine was best placed to consider it. RCEM has already been warning that emergency departments face wider patient safety pressures, with the college saying long waits are linked to harm and, in its latest figures, an estimated 15,860 excess deaths in England in 2025.