A young NHS patient suffering a sickle cell crisis called 999 from his hospital bed to request oxygen, an inquest into his death was told.
Evan Nathan Smith, 21, died on 25 April 2019 at North Middlesex Hospital, in Edmonton, north London, after suffering from sepsis following a procedure to remove a gallbladder stent.
The inquest heard Smith told his family he called the London Ambulance Service because he thought it was the only way to get the help he needed.
Nursing staff told Smith he did not need oxygen when he requested it in the
early hours of 23 April, despite a doctor telling the inquest he had “impressed” on the nurses he should have it.
Smith’s sepsis is thought to have triggered the sickle cell crisis – a condition that causes acute pain as blood vessels to certain parts of the body become blocked.
The football stats analyst called 999 from hospital after nursing staff refused his request for oxygen, which is routinely used to relieve such pain.
Sickle cell disease is caused by unusually shaped red blood cells and is common among people of African and Caribbean heritage.
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Barnet Coroner’s Court heard Smith, from Walthamstow in east London, might have survived if he had been offered a blood transfusion sooner but the hospital’s haematology team were not told he had been admitted.
He was being held in a “lodger” bed – a bed added to a ward for extra
capacity – and did not have access to oxygen or a call bell.
When he was seen by a haematologist later that day, he was prescribed oxygen
but was already in the early stages of a sickle cell crisis.
He suffered a series of cardiac arrests on the night of 24 April and died at 5.55am on 25 April.
A pathologist found his cause of death to be multiple organ dysfunction and cerebral infarction.
Dr Arne De Kreuk, a consultant haematologist who had previously treated Smith at North Middlesex, was not informed of his patient’s presence in
the hospital until the evening of 20 April – two days after he was admitted.
Dr De Kreuk said he would have “appreciated” being informed of Smith’s admission sooner, adding: “With sickle cell disorder, time does matter.”
Martin Forde QC, for Smith’s family,
said: “Do you think that had a transfusion been given when the symptoms appeared on 23 April then the outcome would have been different?”
Dr De Kreuk replied: “On the balance of probabilities, I would say yes.”
When asked if he thought a community such as North Middlesex with a high
prevalence of sickle cell disease should expect a dedicated ward for the
condition, he said: “I totally agree.”
Fellow haematologist Dr Joydeep Roy – the doctor who eventually prescribed Mr Smith the oxygen – said he had “impressed” upon the nursing staff that it was vital he be offered it.
He agreed that he would have mandated a blood transfusion sooner if the haematology team had been aware of Smith’s presence in the hospital.
Coroner Andrew Walker said: “It seems to me that if a patient is identified as having a sickle cell disease, it should be flagged up to the haematology team.”
He added: “A member of that team should be available should a patient show signs of sickle cell crisis.”
Dr Roy said: “I would completely agree. At no point earlier in the week had I been informed. I would have liked to have been informed.”
Mr Walker suggested that haematologists at North Middlesex “should be called upon much more routinely than they perhaps are” and not seen as a hyper-specialised team.
The inquest is due to conclude on Tuesday.
Source: The Independent