Woman's 'Avoidable' Death Caused By Early Discharge

Independent Ombudsman Finds Errors Made During Treatment Of Sepsis


A 62-year-old woman death from sepsis could have been prevented if she had received proper treatment, an investigation has found.

The Parliamentary and Health Service Ombudsman (PHSO) found that 'avoidable' errors were made during diagnosis and treatment that resulted in the woman being discharged after inconclusive tests.

She returned to hospital several more times, complaining of abdominal pain and blood in her urine. She was eventually admitted for exploratory surgery, but she died before this could take place.

The PHSO investigation in to the 2011 incident found staff at the Imperial College Healthcare NHS trust made errors in assessing the woman's condition, and failed to treat her appropriately in good time.

The trust's complaint handling in regards to the incident was also found to be poor.

Ombudsman Julie Mellor said: "Our investigation found that because of a series of errors at a hospital a woman lost her life.

"Her husband told us that he has lost his best friend just before he and his wife were due to start a new life together.

"We hope our investigation and the action taken by the trust will reassure him that lessons have been learnt as a result of his complaint so that others are less likely to suffer the same experience."

Expert Opinion
Through our work we have a number of cases similar to this one in which sepsis, also known as blood poisoning, has led to deaths. It is an incredibly worrying trend considering that the condition can be treated relatively easily if it is diagnosed quickly.

"Behind every death related to sepsis are families and communities left devastated by the loss of a loved one and this should never be forgotten. This case is another stark reminder of the need, where possible, for lessons to be learned from such incidents so that other patients do not face the same problems."
Mandy Luckman, Partner