Patients ‘beg’ not to go to Ysbyty Glan Clwyd, inquest hears

Vivienne Greener, who taught at Ysgol Mair for 30 years, died at the Bodelwyddan hospital on March 20, 2018 aged 64 after coughing up blood earlier that night.

At the second day of the full inquest into her death, held in Ruthin today (December 12), it was heard that the seriousness of Mrs Greener’s condition, which included vomiting “enormous” amounts of blood, was not escalated to the appropriate level and that doctors did not do enough to help her.

The inquest heard that Mrs Greener was evaluated by Dr Chukwuemeka Nwaneri and Zoe Mahmood, a junior staff nurse at the time.

At around 2.40am, Ms Mahmood called Dr Eve Blakemore, acting medical registrar on the night, telling her she “needed to come now” because she felt Mrs Greener “wasn’t getting the input and treatment” from Nwaneri that the patient needed.

Vivienne Greener. (Image: Family handout)

Dr Blakemore, who said that the night in question was “one of the worst night shifts I’ve experienced” and that the ED department was under “extreme stress and strain”, recalled being “shocked” at how unwell Mrs Greener was upon her arrival.

She was told by Dr Nwaneri that Mrs Greener had been vomiting and passing blood and that an “urgent” review was needed, and said that the patient being referred to herself was “inappropriate” as Mrs Greener had not been stabilised or given treatment.

Dr Blakemore said Dr Nwaneri had not escalated the situation to his consultant, Dr Mark Anderton, and that he was never informed of the seriousness of Mrs Greener’s condition.

Ms Mahmood then advocated for the use of blood product, due to the sheer loss of blood, but Dr Nwaneri rejected the idea until blood test results came back, Dr Blakemore said.

After her arrival, Dr Blakemore said that no A&E doctors were involved with Mrs Greener again, and that herself and Ms Mahmood stayed with the patient for the remainder of the night.

Asked by David Pojur, assistant coroner for North Wales East and Central, if this was how the system was supposed to work, she replied: “No.”

Dr Blakemore described Mrs Greener as “one of the sickest patients by far in the entire hospital that night”, and continued to ask for specific specialties that did not arrive until it was too late.

READ MORE:

Potentially lifesaving procedure was unavailable for late Rhyl teacher

Glan Clwyd ‘at breaking point’ as calls made for community hospital

Prestatyn mum speaks out after daughter’s ordeal at Ysbyty Glan Clwyd

She said that Mrs Greener required an endoscopy to determine the source of blood loss, but that this procedure was unavailable due to it not being a provided service at nighttime and on weekends.

Describing the situation as “horrendous” and “worrying”, Dr Blakemore said herself and Ms Mahmood attempted to escalate the situation several times, but that this information was not relayed to surgical or anaesthetic teams.

Dr Blakemore said that some time after 3.20am, senior anaesthetic registrar Dr Syed Raza attended, stood at the foot of the bed, did not examine her, looked at the heart rate and blood pressure numbers and said “She’s alright, she doesn’t need intensive care input.”

She added that Dr Raza did not help her or Ms Mahmood, did not look at her notes or make any documents himself, and that at this point it felt they were “going round in circles”.

Dr Blakemore said that Mrs Greener knew how unwell she was, and had asked her and Ms Mahmood to have her daughters sent home because she “didn’t want them to see her die”.

She said that in the last hour of her life, Mrs Greener, whose condition was quickly deteriorating, “knew she was going to die”.

After being unable to contact endoscopy practitioners, including querying with Wrexham Maelor, the situation was finally escalated to surgical and anaesthetic consultants, with Dr Raza and Dr Iolo Roberts, at the time an anaesthetic trainee based in the Intensive Care Unit (ICU), later helping assess the next step of treatment.

Dr Blakemore asked Dr Raza to speak to his ICU consultant Dr Venkat Sundaram, who was eventually contacted at around 5.30am.

Despite having earlier disregarded ICU as an option due to the endoscopy still being required, and not contacting his consultant, Dr Raza was advised by Dr Sundaram to transfer Mrs Greener to a high-dependency unit at around 5.48am.

It was as they were preparing to move the patient to ICU that she went into cardiac arrest, and despite attempts to resuscitate her and CPR being administered, she died of blood loss at around 6.43am.

Dr Blakemore told the inquest that she and Ms Mahmood were “very angry” that help had come so late, as they could see the distress Mrs Greener was in, and the level of bleeding.

She said that doctors “should have known when I asked them repeatedly to come that this was a seriously unwell patient”.

Dr Blakemore, now a GP at Clarence Medical Centre in Rhyl, added that “patients beg me not to send them specifically to Glan Clwyd”, due to the extreme amount of pressure it is under, and because “you can expect to be sat on a trolley, in corridors and in the waiting room for hours”.

Asked why Mrs Greener was not helped earlier despite heavy bleeding, Susan Davies, deputy sister at the ED, and the shift lead on March 20, answered: “I don’t know.

“I would expect the ED department to be on top of that – having said that, the department was incredibly busy at the time.”

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