Coroner blasts disabled girl’s medical care

A disabled girl died in hospital following a catalogue of errors by medical staff who provided a level of care that was “inadequate” and “simply not acceptable”, a coroner has ruled.

Emma Stones, 12, died from septicaemia, or blood poisoning, after being admitted to Tameside General Hospital in Ashton-under-Lyne, Greater Manchester, in February 2011 with flu-like symptoms.

Staff failed properly to monitor Emma, who had cerebral palsy and a mental age of five, skipped important checks and did not maintain her medical notes properly because they were “busy”, the inquest into her death at Stockport Coroner’s Court heard.

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When her father Michael Stones arrived at the hospital the morning after her admission, he was told she had just died. But her body was “ice cold”, showing signs of rigor mortis and she may have been dead for more than four hours, coroner John Pollard said, recording a narrative verdict.

Emma’s parents, Mr Stones and Tracy Futcher, of Dukinfield, Greater Manchester, said they were disgusted by the “horrific” treatment their daughter received at the hands of doctors and nurses, and are seeking legal advice.

When Emma was admitted to hospital, doctors initially thought she had pneumonia. They later changed their diagnosis to “a bit of a viral illness” but the new diagnosis was not recorded, Mr Pollard said.

The inquest heard a junior doctor did not take a blood test because her senior colleague was too busy and Emma’s blood pressure was not taken. Nurses also failed to monitor her overnight and one disregarded a pulse rate of 180 as a false reading.

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A nurse was suspended for a month and later received a warning at an internal disciplinary hearing before resuming her job, the inquest has heard.

Mr Pollard said evidence suggested Emma could have died at 4.30 or 5am. “Emma was not monitored properly or at all in the hours before her death and when her father held her, she was cold and stiff,” he said. “Mr Stones was understandably concerned that he was told his daughter had died at 8.50am, when she was cold by nine o’clock.

“From 5am onwards, there is every reason to believe that, sadly, Emma had already died.

“I’m quite satisfied that the nursing and medical care of Emma at Tameside General Hospital fell below the standard that most people would consider satisfactory.”

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Mr Pollard recorded a narrative verdict that Emma died of septicaemia but said it was likely that she would have survived were it not for the “inadequate” shortcomings of those looking after her.

He said her parents had endured a “long and painful experience” during a “complex, sad inquest”.

Speaking after the hearing about Emma’s treatment, Mr Stones, who was Emma’s carer, said: “I’m disgusted and appalled by it. It beggars belief and lessons have to be learned from it.”

He and Ms Futcher said intend to take further legal advice. In a joint statement, they said: “Emma was a lovely girl who we all loved very much. She deserved much better care than what she received. Something has to be wrong if this can happen in an NHS hospital.”

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In a statement, Tameside General Hospital said it accepted it failed Emma and offered its sympathies to her family.

Tariq Mahmood, Tameside Hospital’s medical director, said: “Emma was a regular patient in our Children’s Unit and we knew her family well. We would like to send our heartfelt sympathies to them during this difficult time.

“This has been a lengthy and thorough investigation by the coroner which we have fully supported and we accept his findings today.

“We acknowledge that the standard of care which we gave Emma was not acceptable.”