Lawyers Urge NHS To Review Procedures To Help Save Lives

The family of a mum-of-two who died hours after being discharged from hospital have demanded lessons learnt from her case be shared throughout the NHS after an Inquest found a failure to carry out basic investigations and a lack of communication between staff contributed toward her death.

Susan Tatum’s distraught husband David, 62, claims that his wife was ‘let down in the worst way’ by staff at Tameside General Hospital including a junior doctor who failed to keep her in hospital to observe her condition and discharged her with medication that she was allergic to. Susan was left writhing in pain and died hours later at her family home in Ashton Under Lyne.

David’s views were echoed by Stockport’s Coroner, Mr John Pollard, who last week (Thursday 10 May) recorded a narrative verdict into Susan’s death, concluding that, due to the ‘acts and omissions’ of staff at Tameside hospital, Susan was not given any effective treatment for her bowel condition, and did not undergo investigations and surgery which would have been likely to save her life.  The coroner found the cause of Susan’s death was an infection as a result of her bowel bursting and leaking faeces into her body.

Now, medical negligence lawyers at Irwin Mitchell are demanding that the Trust reviews its discharge procedures to prevent the errors in this case ever being repeated again and to share its findings from any internal review with the rest of the NHS to improve patient safety.

Sarah Sharples, a medical law specialist at Irwin Mitchell’s Manchester office supporting Susan’s family in their battle for justice, said: “Although nothing can change what happened to Susan, or the heartache her family continue to suffer, they want assurances that lessons will be learnt to prevent the needless suffering of any other patients and to help save lives in the future.
 
“Instead of receiving life saving treatment, Susan was sent home and her husband had to endure watching her suffer extreme pain in the hours leading up to her death.

At the Inquest catalogue of failings were outlined by the Coroner including:

• A junior surgical doctor failed to:
  • look at notes which referenced Susan’s allergy to the medication Augmentin
  • advise Susan to seek further medical advice if she developed further symptoms, such as vomiting
  • seek advice from a more senior colleague prior to discharging her.
• Susan’s notes were unclear, undated, unsigned, confusing and misleading which lead to her being prescribed incorrect antibiotics that would not treat her condition
• Nursing staff failed to act when Susan vomited following her discharge but whilst still on hospital premises - if this information had been passed on to doctors, it would have led to further investigations and surgery
• The discharge form contained four errors, one of which was the wrong diagnosis, and was unsigned.

Commenting on his family’s tragic loss, David said: “Sue was a devoted wife, mother, grandmother, sister, aunt and friend. She was a very loving, kind and gentle woman and was an important figure in a lot of people's lives. She has been, and will continue to be, deeply missed by all of her family and friends.

“Towards the end of her life she put her health in the hands of medical staff, trusting them to do everything possible to help her but they let her down in the worst possible way and instead she was sent home to die in pain. To know that more could and should have been done to prevent her suffering is an unbearable thought to live with that will stay with me, and the rest of the family, forever.”

He continues: “To know that Sue could have been saved is heartbreaking. I wouldn’t wish that on anybody so if by speaking out we can, somehow, force change to ensure that this does not happen to anybody else then I, and my family, will feel that in some small way justice has been done.”

Sarah from Irwin Mitchell continues: “What happened to Susan highlights the fact that simple, avoidable errors can have devastating consequences. We support the family’s call for Tameside General Hospital to change the procedure for discharging people, making it essential for a doctor involved in a patients care to be involved in the process.

“We are constantly calling for improvements in standards within the NHS and will continue to campaign for the rights of victims we represent to help save lives and prevent future tragedies like this from ever happening again.

Susan first attended Tameside A&E on 23 August 2010 as she’d been suffering abdominal pains for three weeks and had woken that morning to find blood in her underwear.  Her husband rushed her to hospital, where she was seen by an A&E doctor who thought that she might have a bowel obstruction.

She was then referred to the surgical team and examined by a junior surgical doctor who made a differential diagnosis of diverticular disease or urinary tract infection. He prescribed Augmentin for diverticular disease, which she was allergic to, and discharged her home.

Whilst waiting for her husband to collect her from the door of the A&E department, Susan started to vomit. The Inquest heard that although the nursing staff were aware of this and handed her a cardboard bowl to use, it was not brought to the attention of the medical staff.

The Coroner found that there was never any evidence of Susan having a urine infection and performing a simple dipstick test would have ruled this out. He commented that, in light of Susan’s condition at the time she was seen by the doctor, she should have been kept in hospital. He also said that regardless of the fact she had been discharged, the medical staff should have been made aware she had started to vomit so they could have decided to keep her in hospital. If either of these things had happened then it is likely Susan would have survived.

If you or a loved one has suffered as a result of hospital negligence, we may be able to help you claim compensation. See our Medical Negligence Guide for more information.