London patient, 21, would not have died if staff had recognised symptoms sooner, coroner concludes

Publication Date06 April 2021
Evan Nathan Smith, a 21-year-old football stats analyst from Walthamstow, died on April 25, 2019 at North Middlesex Hospital in Edmonton, north London, after developing sepsis following a procedure to remove a gallbladder stent a week earlier.

The sepsis precipitated a sickle cell crisis in Mr Smith, where red blood cells become crescent shaped and block capillaries and can restrict the flow of blood to an organ.

Sickle cell disease is common among people of African or Caribbean heritage.

Barnet Coroner’s Court heard that nursing staff did not have specific training in managing sickle cell disease, despite serving an area with a large African and Caribbean community.

The deceased was told he did not need oxygen because his blood saturation was high enough.

Mr Smith rang the London Ambulance Service from his hospital bed in the early hours of April 23, but after speaking with nurses about his latest observations, the operator decided not to send paramedics.

He was being held in a 'lodger' bed – a bed added to a ward for extra capacity as no beds were available – and did not have access to piped oxygen or a call bell.

When he was seen by a haematologist later that day, he was prescribed oxygen but he was already in the early stages of sickle cell crisis.

The deceased did not receive an exchange blood transfusion until late on April 24.

He suffered a series of cardiac arrests on the night of April 24 and was confirmed as having died at 5.55am on April 25.

A pathologist found his cause of death to be multiple organ dysfunction and cerebral infarction as a result of sickle cell crisis caused by sepsis triggered by an infection of the bile duct.

In his conclusion, coroner Dr Andrew Walker said Mr Smith’s life might have been saved if a blood transfusion had been administered in the early hours of April 23 or at least at some point the same day.

“In the early morning of April 23, 2019, Mr Smith is likely to have begun to show symptoms of a developing sickle cell crisis, this being precipitated by the ongoing biliary infection,” he said.

“Mr Smith requested oxygen and when this was not provided telephoned the London Ambulance Service asking to be transferred to A&E and this is an indication of how concerned Mr Smith himself was.

“There was a failure to appreciate the significance of those symptoms by those looking after Mr Smith at the time.”

He continued: “Mr Smith required an exchange transfusion and had this taken place ideally in the early morning of April 23...

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