Man, 21, who died in hospital could have been saved, inquest hears

Football data analyst, 21, was forced to call 999 from his bed in a hospital corridor after he was denied oxygen because temporary bed wasn’t suitable despite his organs failing, inquest hears

  • Evan Smith was admitted to North Middlesex University Hospital with jaundice
  • He complained of hip pain and had low blood-oxygen levels classified ‘serious’
  • Medical staff denied him oxygen before he called London Ambulance Service
  • But oxygen could not be provided as he was in ‘lodger bed’ for sleeping only

Evan Smith, 21, was forced to call 999 from his temporary bed in a hospital corridor

A football data analyst was forced to call 999 from his temporary bed in a hospital corridor after he was denied oxygen despite his organs failing, an inquest has heard.

Evan Smith was admitted to North Middlesex University Hospital in April 2019 with jaundice.

He later complained of hip pain and showed low blood-oxygen levels classified as ‘serious’ – but he was declined oxygen by medical staff. 

Mr Smith then called the London Ambulance Service from his hospital bed asking them to take him to A&E.

Staff discussed providing oxygen but it could not be administered because he was still in a ‘lodger bed’ that provided facilities for sleeping but had no access for oxygen ports.

An inquest at North London Coroners’ Court today heard Mr Smith, from Walthamstow, north east London, had a history of sickle cell disease.

A coroner heard how his organs failed after an infection in his bile duct triggered his blood cells to sickle – meaning they change shape, take on far less oxygen, and pose a risk of blocking his arteries – therefore preventing his body from feeding enough oxygen to his brain. 

A post-mortem exam found his cause of death to be ‘multiple organ disfunction syndrome as a consequences of cerebral infarction and sickle cell crisis due to biliary sepsis’.

One of the hospital’s blood specialists, Dr Arne De Kreuk, today told he may have attended and given a potentially life-saving blood transfusion if he was called. 

Staff at North Middlesex University Hospital (pictured) discussed providing oxygen but it could not be administered because Mr Smith was in a ‘lodger bed’

Mr Smith had initially been discharged from North Middlesex University Hospital after undergoing an operation to remove a stent from his bile duct – which had been installed following an earlier gallstone removal.

But around 24 hours later, on April 18, 2019, he was re-admitted with jaundice. 

Five days after that, on April 23, he complained of hip pain and showed low blood-oxygen levels classified as ‘serious’ – but he was denied oxygen and later called paramedics himself. 

Doctors then considered giving oxygen but the plan was halted because his temporary bed, that had been set up in a corridor, was not built to accommodate ‘oxygen ports’.

His condition worsened and, despite doctors ordering a blood transfusion the next day at around 11am, ‘significant delays’ meant he did not get it until later. 

What is sickle cell disease? 

Sickle cell disease is the umbrella term for a group of inherited conditions that severely affect red blood cells.

Around 15,000 people in the UK are sufferers and it is particularly common in people of African or Caribbean descent.

Healthy red blood cells – produced by stem cells within bone marrow – are biconcaved discs that can bend and flex easily.

However, in those with sickle cell disease, faulty stem cells produce red blood cells that are crescent shaped.

They are rigid, unable to squeeze through smaller blood vessels and prone to causing blockages that deprive parts of the body of oxygen. 

Sufferers are not expected to live beyond 60 and treatment mainly focuses on alleviating symptoms, such as pain and infections, through blood transfusions and painkillers.

Mr Smith then tragically died on April 25 at 5.55am.  

Coroner Andrew Walker QC said: ‘On the night of April 23 Mr Smith complained about hip pain and was reviewed by the junior doctor on call. 

‘Oxygen concentrations were 94 per cent.

‘He was declined oxygen by medical staff.

‘Mr Smith had then called the London Ambulance Service to take him to A&E. 

‘They discussed his request for oxygen but this could not be provided because he was in a lodger bed, a bed which proved facilities for sleeping but no access for oxygen ports.

‘He had developed a sickle cell pain.

‘So over the night on April 23 it is likely that a process of sickling had begun.

‘And that would account for the symptoms and fall in oxygen levels. Something Mr Smith himself would recognise form previous episodes of sickling.

‘What was going on was something Mr Smith knew very well was happening.’

One of the hospital’s blood specialists, Dr Arne De Kreuk, today told he may have attended and given a potentially life-saving blood transfusion if he was called.

He said: ‘Unfortunately I wasn’t informed and neither was my colleague, who was on call, so the junior doctor reviewed the patient and made their own decision and didn’t escalate the situation.

‘If I had the phone call at that time with a saturation of 94 per cent and an increase in pain I guess I would have probably initiated the transfusion process.

‘I do think that by the time the transfusion was completed, the damage had already happened. And so if we would have started the transfusion in the very early hours of the morning we might have been able to control the damage better.’

When asked directly if it could have saved Mr Smith’s life, he added: ‘On the balance of probability, I would say yes.’

The court also heard how he was not tested for an infection after the stent was removed because guidelines did not recommend them in cases where there were no symptoms.

Dr Debasis Mujamadar, who carried out the stent removal, told the court: ‘It is easy to see because you can see the colour of the bile that’s coming, the granulation of the tissue. There are many things we see during the stent removal that would show there was an infection – none of that was present here.’

Coroner Andrew Walker QC added there was ‘disjointed communication’ among the haematology department.

The inquest also heard how the area the hospital covers has a high population of Afro-Caribbean residents, who are most susceptible to sickle cell, but lacked a specialist ward that doctors say could have made a difference.

Such a ward has now been created and is manned by special trained nurses, the coroner was told.

Dr De Kreuk added: ‘I have a very strong view of that, North Middlesex has been commissioned as specialist haemoglobin centre – one of 24 in England – and, in my view, that implies that you have the expertise on board to look after these patients so I feel very strongly that a hospital like ours would have a dedicated ward.’

The inquest continues.

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