Coroner's concern at out-of-hours doctor support services at Kingston Hospital

This Is Local London: Coroner's concern at doctor delay death Coroner's concern at doctor delay death

The death of a 94-year-old man has raised concerns about the out-of-hours doctor support services at Kingston Hospital.

Bruce Paterson died from a severe stomach haemorrhage after a delay in receiving blood for transfusion and a lack of doctors to perform an endoscopy, South West London Coroner’s Court heard.

The inquest heard junior doctors tried to stabilise the Teddington pensioner and frantically rang gastrologists for help but could not get through.

Mr Paterson was admitted to Kingston Hospital after he suffered a stroke on December 17, last year.

He had a temporary nasal tube inserted and remained in hospital until January 21 this year, when a permanent feeding tube was inserted into his stomach and caused the stomach haemorrhage.

At the inquest on Tuesday, November 20, Coroner Dr Sean Cummings raised concerns over the hospital’s ad-hoc arrangement with the bleed support service, given the risk of haemorrhages after tube insertions.

He said: “There is a question to whether it can be done safely if they have known side effects that can result in death because those side effects can’t be dealt with in the hospital.”

The hospital has a Monday to Friday 9am to 5pm support service but doctors work on an ad-hoc basis in the evenings and at weekends.

Dr LiLian Choy, a consultant physician who was responsible for Mr Paterson’s medical care, said it was not unusual for a hospital not to have a 24-hour endoscopy or gastrology service.

She said: “A lot of people have GI bleeds and we are able to stabilise them. In an ideal world we would have a 24 hour on-call service.”

Dr Tim Heyman, an on-call doctor at Kingston Hospital, said the ad-hoc arrangement had worked well for 16 years and was a system in place at 60 per cent of NHS trusts.

He said it was likely the outcome would have been the same for Mr Paterson even if he had been given an endoscopy, as the procedure puts a huge strain on patients.

He said: “Do I think we can continue to do this without a formalised GI bleed rota?

“Yes, I do, because I think that such complications are extremely rare.”

Dr Cummings concluded Mr Paterson died of “an enormous and catastrophic haemorrhage” and said he would write to the hospital about his concerns.

A spokesman for Kingston Hospital NHS Trust said: “We would like to offer our condolences to Mr Paterson’s family for their sad and tragic loss.

“Following Mr Paterson’s death a full investigation was carried out by the hospital, the results of which, showed that having an endoscopy could not have prevented his death.

“However, the investigation into his death highlighted some improvements which could be made to our out of hours arrangement. We are currently in the final stages of implementing these changes.”

Comments (4)

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2:49pm Sun 25 Nov 12

Culverin says...

I think it's very worrying to hear hospitals sound so relaxed at an unnecessary death.

My impression is that Kingston aren't a 24 hour hospital and it's a horrible situation to put patients in. Had Mr Paterson been 34 would he be alive or is it the same for everyone?

Surely there has to be a 24 hr element to all hospitals, you can't plan when to have a gastric bleed - what happened to on call consultants? Did they become too expensive? Horrifying.
I think it's very worrying to hear hospitals sound so relaxed at an unnecessary death. My impression is that Kingston aren't a 24 hour hospital and it's a horrible situation to put patients in. Had Mr Paterson been 34 would he be alive or is it the same for everyone? Surely there has to be a 24 hr element to all hospitals, you can't plan when to have a gastric bleed - what happened to on call consultants? Did they become too expensive? Horrifying. Culverin
  • Score: 0

10:34pm Sun 25 Nov 12

EdwinaWaugh says...

Culverin, I agree with you. Perhaps Kingston Hospital has adopted the Liverpool Care Pathway.
Culverin, I agree with you. Perhaps Kingston Hospital has adopted the Liverpool Care Pathway. EdwinaWaugh
  • Score: 0

8:58am Mon 26 Nov 12

little smiff says...

This lack of 24 hour cover is not only in practice at Kingston hospital. Following mis - diagnosis by "on cover" doctor my mother (81) was admitted to St. Helier over the Easter weekend earlier this year. Due to a shortage of staff, "it's Easter you know" was the reason given, she was left on a ward without regular visits by a doctor and ended up having life saving emergency surgery 24 hours after being admitted. Two days in IT and two weeks on a ward. How can the cost of all that time and treatment be offset against paying staff to work over public holidays? Somewhat ironic that my son works in the leisure industry and they are only shut for Christmas Day and Boxing Day with a full compliment of staff at all times. You tell me which is more important!
This lack of 24 hour cover is not only in practice at Kingston hospital. Following mis - diagnosis by "on cover" doctor my mother (81) was admitted to St. Helier over the Easter weekend earlier this year. Due to a shortage of staff, "it's Easter you know" was the reason given, she was left on a ward without regular visits by a doctor and ended up having life saving emergency surgery 24 hours after being admitted. Two days in IT and two weeks on a ward. How can the cost of all that time and treatment be offset against paying staff to work over public holidays? Somewhat ironic that my son works in the leisure industry and they are only shut for Christmas Day and Boxing Day with a full compliment of staff at all times. You tell me which is more important! little smiff
  • Score: 0

9:35am Mon 26 Nov 12

jeremyhm says...

I think you will find, if you enquire, that the EU Working Hours Directive has a lot to do with this
I think you will find, if you enquire, that the EU Working Hours Directive has a lot to do with this jeremyhm
  • Score: 0

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