Dying patient should have been seen in person

11 months ago 58

By Sean Clare & David Grossman
BBC Newsnight

David NashImage source, Andrew Nash

Image caption,

David Nash had an abscess connected his brainstem, which was listed arsenic a origin of death

NHS officials ruled a antheral who died aft his receptor corruption was not picked up successful GP telephone consultations should person been seen look to face, a BBC Newsnight probe has found.

David Nash, 26, had 4 distant consultations implicit 3 weeks during Covid restrictions but was ne'er offered an in-person appointment.

His corruption led to a fatal abscess connected his brainstem.

The surgery, successful Leeds, said it could not remark up of an inquest.

Medical documents and recordings of the consultations suggest helium should person been fixed a face-to-face assignment connected 1 of the 4 consultations helium had, according to NHS England.

David archetypal spoke to the signifier connected 14 October 2020, aft uncovering lumps connected his neck.

He sent a photograph but was ne'er examined.

With David disquieted the lumps mightiness beryllium cancerous, the GP asked a bid of questions astir his wellness and reassured him that portion she could not regularisation it retired completely, she was not disquieted astir cancer.

She suggested helium booked a humor trial for 2 to 3 weeks' time.

In those 3 weeks, David would spell connected to talk to different GP and 2 precocious caregiver practitioners but ne'er look to look oregon via video call.

BBC Two's Newsnight programme has heard the calls and seen documents relating the case.

  • 23 October: David spoke to a nurse, reporting receptor symptom and aft a five-minute consultation was prescribed receptor drops for an outer-ear infection. In fact, helium had a middle-ear infection.
  • 28 October: David reported humor successful his urine and a fever, which the doc treated arsenic a urinary-tract infection. This is contempt the information UTIs successful young men are "generally uncommon", according to National Institute for Health and Care Excellence (NICE) guidelines, and the doc himself stating successful the call: "You don't look to person immoderate different signs of a urine infection."
  • 2 November: In the 4th and last call, David said helium had debilitating cervix symptom preventing him sleeping, symptom successful his sinuses, had had fever for 10 days and was slurring his words. The caregiver helium spoke to diagnosed a flu-like unwellness and prescribed symptom alleviation for his neck

"Pretty overmuch each clip my bosom beats, I'm getting these pains," David told the nurse.

He was really owed to beryllium seen successful idiosyncratic astatine the GP country that day, for the humor tests booked immoderate 19 days earlier, erstwhile helium had presented with cervix lumps.

But - fearing helium could person coronavirus, contempt a antagonistic PCR trial - the caregiver cancelled the bloods and asked David to retest for Covid.

In its investigation, NHS England recovered "the overarching payment [of this decision] was little than the hazard with going up with humor tests".

'Appalling care'

"What we cognize now," David's father, Andrew Nash, told Newsnight, "is that a mates of days previously, helium much than apt started to make a encephalon abscess that was triggered by his ongoing corruption successful his ear.

"Two and a fractional hours aft that call, David took a selfie of himself to nonstop to a friend."

Image source, Andrew Nash

Image caption,

David with his mother, Anne

Newsnight has seen the picture, the past taken of David alive.

"I person nary ceremonial aesculapian grooming different than archetypal aid," Andrew said. "But if I was to place a representation of idiosyncratic who was dying..."

After 5 calls to NHS 111, David was taken to infirmary successful an ambulance that time but died 2 days later.

NHS England - successful a uncovering seen by Newsnight - said: "A face-to-face appraisal should person been offered oregon organised to corroborate the diagnosis and initiate definitive management."

Andrew added: "He made galore attempts to entree attraction and determination were truthful galore opportunities where, had helium been seen face-to-face, things would person been different."

His wife, Anne, said: "It's been appalling care. I deliberation they've wholly fto David down… astatine each azygous point.

"I americium perfectly convinced, arsenic David's mum, that if he'd been seen connected that past consultation, helium would inactive beryllium with america today."

'Clinical risk'

An inquest into David's death, scheduled for aboriginal adjacent year, is expected to besides analyse what his household accidental were failures erstwhile helium had been admitted to hospital.

Image source, Andrew Nash

Image caption,

Andrew Nash said his lad had made galore attempts to entree treatment

In documents seen by Newsnight, an autarkic GP adept who has looked astatine the lawsuit successful item said determination were "several points successful clip wherever David should person been reviewed look to face".

Dr S L Brown - a GP since 1984 - said helium could not find whether David being seen earlier would person changed the result but to prescribe symptom alleviation erstwhile helium had been truthful unwell "was a breach of duty".

In a statement, David's country said: "We would similar to again widen our condolences to Mr Nash's household and our thoughts are with them astatine this hard time.

"It would not beryllium due to remark further arsenic the inquest is ongoing."

NHS England, North East and Yorkshire, which investigated David's death, offered its condolences to the family.

"We person investigated the family's ailment regarding their son's attraction wrong superior attraction and provided them with a response", it said successful a statement.

An NHS England spokesperson said: "The NHS has made it wide that each GP signifier indispensable connection look to look arsenic good arsenic telephone and online appointments, and that objective judgement alongside diligent penchant indispensable beryllium considered."

In June, the Nuffield Trust published a study that recovered "the objective hazard from distant consultations is not yet good understood".

"Remote consultations besides transportation immoderate risks - missed oregon delayed diagnoses owed to nonaccomplishment of accusation from ocular clues, carnal introspection and 'door-knob' concerns [fresh issues raised by patients towards the extremity of face-to-face consultations], missed signs of safeguarding risk, mislaid opportunities for public-health interventions and accrued usage of investigations and referrals to different services," the study said.

A Department for Health and Social Care spokesperson said: "We are wide that practices should respect diligent preferences for in-person appointments wherever expressed."

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