Potentially lifesaving procedure was unavailable for late Rhyl teacher

Vivienne Greener, who taught at Ysgol Mair for 30 years, died at the Bodelwyddan hospital on March 20, 2018 aged 64.

At the first day of the full inquest into her death, held in Ruthin today (December 11), it was heard that Mrs Greener was admitted to hospital shortly after midnight that day after coughing up blood.

But despite it transpiring that she required an endoscopy – a procedure to look inside a patient’s body – this was found to be unavailable anywhere in North Wales at that time of night.

David Pojur, assistant coroner for North Wales East and Central, said he found it “startling” and “sobering” to hear that the “chaotic” state of affairs at Glan Clwyd’s emergency department (ED) had almost become “normalised”, meanwhile.

READ MORE:

Rhyl woman’s death ‘potentially avoidable’, inquest opening hears

Ambulance delays cost Prestatyn lady 'timely' treatment, inquest hears

Baby’s death at Ysbyty Glan Clwyd likely preventable, inquest rules

Mrs Greener’s husband, Philip, told the inquest that his wife was a “generally healthy person”, who “ailed very little in the 43 years I knew her”.

She had become “really unwell” towards the end of 2016, he said, and though she initially recovered, Mr Greener said she deteriorated again at about Christmas of 2017.

By then, Mrs Greener had, as previously, began to eat less and feel generally unwell, but was said to be wary to see a doctor as “she always felt as if she was wasting their time”.

In early 2018, she developed lesions, which were seen to at Glan Clwyd, with a specialist advising that no specific treatment was required, and that “time and rest would make it go away”.

Mrs Greener was “pretty much bed-bound again” by February 2018, her husband said, adding his concern that her previous infection had returned, but this time having caused an additional problem by way of her lesions.

On March 19, the day before Mrs Greener’s death, she was by then awaiting the results of a biopsy, when she called out for her husband at home and said: “I think I’m in trouble.”

Mr Greener immediately made a 999 phone call and asked for an ambulance after finding that Mrs Greener had filled a sink with blood.

Ysbyty Glan Clwyd, Bodelwyddan (Image: Newsquest)

An ambulance arrived about one hour later; during the 11-minute drive to Glan Clwyd, blue lights were not deployed and all speed limits were adhered to.

Though, Mr Greener said he was “quite reassured by that” as it made him think the situation was not “as bad as it looked”.

Mrs Greener arrived at Glan Clwyd after midnight on March 20, but was not transferred from the ambulance to hospital for roughly another hour, during which time she lost more blood.

Once in the hospital, it was felt that Mrs Greener required an endoscopy to find the source of her bleeding, but that this was procedure was unavailable at Glan Clwyd or elsewhere in North Wales at that time.

She “lost so much blood” before she died at the hospital several hours later.

A provisional cause of death for Mrs Greener has been given as multi-organ failure due to sepsis.

Mr Greener said it “causes me a lot of concern” that an endoscopy was unavailable, not only in his wife’s case, but for other patients in a potentially similar situation.

“In the hours and days that followed, I couldn’t shake off the feeling that something wasn’t right here,” he said.

Coroner's Court, Ruthin (Image: Newsquest)

Arwel Owen, an emergency medical technician with the Welsh Ambulance Services Trust (WAST) at the time, attended Mrs Greener’s address following an emergency call.

He recalled that, upon arrival, she had a high pulse rate of 125bpm, but seemed otherwise “quite stable”, and experienced a “comfortable” journey to Glan Clwyd.

She arrived at Glan Clwyd’s ED at 12.21am on March 20, but was not taken straight in to the hospital due to it being a “very busy night” and there initially being no beds available for Mrs Greener.

At 12.38am, further observations were taken which showed that her blood pressure had dropped slightly, her high heart rate remained, and her oxygen saturation levels had dropped “dramatically”.

The latter, Mr Owen said, was a “big cause for concern” and required urgent action – he said he raised this with the nurse in charge of the ED, but was told there was still no availability for her.

John Owen, duty operations manager at WAST, said Mrs Greener’s case was escalated to him as a more senior and experienced member of staff.

He recalled that she “didn’t look well at all”, so also alerted the nurse in charge of the ED.

Ysgol Mair, where Mrs Greener taught for 30 years (Image: Newsquest)

Susan Davies, deputy sister at the ED, was the shift lead on March 20.

She told the inquest that even the ED’s corridors were “full to capacity” at the time, and admitted that there are “never enough” nurses to deal with the demands on the department.

Ms Davies said the issue of staff essentially “firefighting” is still a problem now, as it was then.

“It gives me pause to hear that the ED is just overrun,” Mr Pojur said.

“You’ve got a lot of ground to cover, literally.”

She replied: “We are overrun, yes. Any space I could find, I would fill it. It can be quite a frightening place to work.”

Ms Davies said she had not been informed that Mrs Greener’s condition had worsened while in the ambulance until John Owen raised the issue with her.

Had a “pre-alert” been issued for Mrs Greener, Ms Davies said, she would have looked to clear a bed in the hospital’s resuscitation services area for her.

Zoe Mahmood, a junior staff nurse at the time, saw to Mrs Greener at Glan Clwyd, saying she appeared “very pale” and “extremely unwell”.

Asked by Mr Pojur if all that could have been done to save Mrs Greener was done, she answered: “From a nursing point of view, yes.”

Mr Pojur will record Mrs Greener’s medical cause of death and a conclusion of the inquest on Thursday (December 14).