A WOMAN from Rhyl who died after suffering a stroke waited more than four hours for an ambulance to arrive at her home, an inquest heard.

Angela Margaret Clarke, of Francis Avenue in Rhyl, died aged 58 at the Walton Centre, a neurology hospital in Liverpool, on February 21, 2024.

At the resumption of the inquest into her death, held in Ruthin today (September 19), Elizabeth Dudley-Jones, assistant coroner for North Wales East and Central, gave a narrative conclusion of natural cause of death.

Ms Dudley-Jones provided a medical cause of death of cerebral infarction (a stroke).

Born in Stoke, Mrs Clarke had moved to Colwyn Bay and then to Rhyl, and lived with and cared for her son Kemal, who has Aspergers and autism.

Her son was “the light of her life” and the two “doted upon each other”, with Kemal always affectionately referring to her as “mother”.

She had also previously cared for her husband Andrew, who was by then living in care.

She was described by her neighbour Claire Taylor-Jones as a “kind, funny” woman who had “little or no support from anywhere and often had to do it all alone”, and “always did her best for her family”.

On February 6, Mrs Clarke, who was a smoker, had undergone a coronary angiogram which had detected no blockage of any of the blood vessels around her heart.

However, at approximately 1.14am on February 11, her son called the Welsh Ambulance Service because he thought she was having a stroke.

At around 1.30pm, he informed neighbours that he “needed help” with her as he remained engaged to call handlers.

Mrs Clarke “looked unwell”, was now in a “bad way”, neighbours said, and was “becoming more unwell as the minutes went by and appeared to be having another stroke”.

In the next four hours, five calls were made to ambulance services, with four of these calls flagged as ‘Amber 1’ category calls – meaning life-threatening – although because she was conscious this was not upgraded.

Only one call, made at 1.56am, was categorised as red, after Mrs Clarke vomited blood and was designated as haemorrhaging.

This call was then downgraded to Amber 1 after she returned to an alert and responsive state.

Gillian Pleming, head of utilisation for North Wales at Welsh Ambulance Service, told the inquest that every call was correctly categorised and “appropriate”.

Ms Pleming said that at the time there was “severe pressure” on the ambulance service’s system, but that following an investigation “no missed opportunities” were found in relation to Mrs Clarke’s death.

An ambulance arrived at Mrs Clarke’s home at 5.23am, by which time her speech was slurred and she was experiencing left sided weakness.

The wait had left those who were with her “infuriated”, and she was taken to Ysbyty Glan Clwyd, and was admitted to the stroke ward at 6.08am.

Dr Richard Pugh, a consultant in anaesthesia and intensive care medicine at Ysbyty Glan Clwyd, said she was discovered to be suffering from a stroke, and underwent two scans which showed “evolving” and “malignant” swelling in her artery.

But she was unable to undergo thrombolysis treatment to remove the blood clot from her artery, due to this usually being performed only with four and a half hours of symptoms arising.

Dr Duncan Black, a consult physician specialising in strokes at Ysbyty Glan Clwyd, told the inquest Mrs Clarke’s “very massive” stroke meant he “can’t say with certainty that thrombolysis wouldn’t have had an affect”.

For a “chance at survival”, she was transferred to the Walton Centre, where she underwent an emergency operation – a decompressive craniotomy.

However, she did not come round after a “couple of days” and never regained consciousness (even developing diabetes).

Mrs Clarke died on February 21 surrounded by her family and friends.

Recording a narrative conclusion, Ms Dudley-Jones said Mrs Clarke had been “denied” the opportunity of more treatment due to the wait for an ambulance.

She called Mrs Clarke’s death a “complete tragedy”, and wished Mrs Clarke’s son her sincerest condolences.