Expert Concerned By Serious Failings

A woman left with serious brain injuries after she collapsed and was forced to wait more than 100 minutes for an ambulance sitting just 100 metres from her home has won her legal fight for London Ambulance Service to admit it was in the wrong.

The delay in emergency treatment left 33-year-old Caren Paterson with a number of long-term brain injury symptoms including chronic amnesia, anger outbursts, confusion and disorientation.

Now her lawyer, John Davis, from serious injury specialists Irwin Mitchell, is demanding urgent improvements in the handling of 999 calls in London after the capital’s ambulance service admitted 11 separate breaches of duty that contributed to Ms Paterson’s injuries.

The 11 breaches focused broadly on:

• The delay in the ambulance attending the scene caused by a failure to comply with hospital trust policies
• The Emergency Centre of Operations’ failure to communicate properly and effectively both with the police and the caller
• Failure to react properly to the patient’s worsening condition

Ms Paterson collapsed in the bedroom of her Islington flat early in the afternoon of Saturday, 27th October 2007 and her condition quickly deteriorated – prompting her boyfriend to call 999 at 1.39pm and report that she was unconscious, breathing abnormally and her lips were blue.

However, because Police had previously been called to Ms Paterson's Hargrave Road, Islington address, it was flagged as being on the 'High Risk Address Register' and the ambulance crew was told to wait for a police escort.

There were no police available at that time and, despite a further two 999 calls from her partner, the emergency medical team waited for over an hour just 100m from her flat.

Ms Paterson, who had been working as a researcher at King's College Hospital, eventually suffered a cardiac arrest at around 3.15pm, five minutes before police and an ambulance team arrived. Though she survived, she has been left with complicated long-term care needs.

Mr Davis, who is working with the Paterson family to secure a long-term care package that will provide Ms Paterson with the support she now needs, said it was unknown why the address was on the high risk register, adding that because her flat was one of several at the same address, the grading could have related to a different flat, or have been placed on there several years previously before Ms Paterson moved into the house.

He said the delays that this caused were unacceptable and welcomed the Police's decision to review the way emergency calls to homes on the High Risk Address Register were handled.

Davis added that the failings amounted to more than a simple breakdown in communication and had left a woman fighting for her life as a result of a hypoxic brain injury, caused by a number of delays to her treatment.

He said: "There is a list of failings and breaches of duty that occurred in response to the 999 call. It is particularly heartbreaking for Ms Paterson’s family to know that an emergency response team was in very close proximity to her but unable to give her the crucial treatment she needed. 

"The emergency crews eventually arrived 102 minutes after the first 999 call – but even then there was nobody senior enough on hand to administer the treatment that Ms Paterson needed.

"It is imperative that people in Ms Paterson's condition are treated as quickly as possible – even seconds can make a huge difference, let alone over an hour and a half.

"The emergency services had been made abundantly aware of the seriousness of her condition yet failed on several levels to handle the situation in accordance with their own guidelines.

"But for these failings and contraventions, Ms Paterson would have received appropriate medical treatment sooner, would have been taken to A&E sooner, and consequently would not have suffered the injuries she did.

"Following Ms Paterson's case, it has been acknowledged that the way the High Risk Address Register was operated needed to be 'radically overhauled' – we endorse any review and improvement to this system which was clearly at the heart of the failings in this case.

"We appreciate the London Ambulance Service's admission of liability for the failings and we will now be working to secure a care package that will allow Ms Paterson to live in as much comfort as possible, and will afford her family some degree of peace of mind."

Ms Paterson was initially taken to the Accident and Emergency Department of Whittington Hospital before being transferred to intensive care for seven days. She was eventually moved to the Reckitt Ward of the same hospital where she remained until the end of 2007.

She was moved in early January 2008 to the Walkergate Hospital in Newcastle, near her family home in Warkworth, Northumberland. She was subsequently admitted to the Daniel Yorath House facility of the Brain Injury Rehabilitation Trust (BIRT) in Leeds, and then moved once more in September 2008 to BIRT's York House, where she remains in care to this day, receiving ongoing occupational therapy, physiotherapy and Neurobehavioural assessment.

Her mother, Eleanor Paterson, from Warkworth, Northumberland, said: "We welcome the admission of liability as a significant step towards ensuring Caren will continue to receive the care, treatment and specialist attention she will need for the rest of her life, but nothing will return our daughter to the way we knew her.

"The thought of an ambulance crew sitting waiting while my daughter lay in her flat as her condition went from serious to life-threatening, causing irreparable damage to her brain, is still shocking.

"Although I appreciate fully that the emergency services have guidelines in place, I now know that there were further procedures that should have been followed and, if they had been, my daughter would have received the treatment she needed."

The 11 failings listed were:

1. Delay of 102 minutes between the 999 call and the arrival of the ambulance at Caren's address
2. Failure to comply with Trust policies thus leading to the delay in the arrival of the ambulance at Caren's address
3. Inadequate communication by the Emergency Operations Centre (EOC) with the Metropolitan Police Service (MPS) control room which led to the delay in the arrival of the ambulance at Caren's address
4. Failing to recognise that there was no danger to the ambulance crew which would prevent the immediate dispatch of an ambulance to Caren's address or alternatively, failed to make enquiries of the emergency caller which would have yielded information to the effect that there was no such danger
5. Failure by the EOC to provide the MPS with complete information via the electronic CAD system or at all
6. Failure by the EOC to make the MPS aware of the life-threatening nature of Caren’s condition; the information provided to MPS at 13:42 was misleading in that it stated only that the patient was unconscious and that it was drink-related
7. Failure by the EOC to make telephone contact with the MPS to explain the urgency of the situation
8. Failure by the EOC to take any action in respect of the emergency calls between 14:05 and 14:40 and 14:48 and 15:17
9. Failure by the EOC call taker, upon receipt of the second emergency call at 14:42, to react to the clear signs of Caren’s serious respiratory distress which were clearly heard during that call
10. Failure by the EOC to maintain proactive regular contact with the ambulance crew; this contravened Control Services Operational Procedure 016; had this procedure been followed, the crew would have been in a better position to undertake a dynamic risk assessment of the situation and to act accordingly
11. Contravention by the EOC of Control Services Operational Procedure 016, by failing to consider dispatching, and failing to dispatch, a Team Leader or Station Officer to the scene of the call until 15:28 and only then in response to a request by MPS officers made at 15:27