Hospital neglect led to death

QUEEN S Hospital was said to have shown gross failings in care and neglect when an elderly patient died from infected bedsores after being twice left for 19 hours on an A&E trolley. Parkinson s sufferer, Walter Gibson, 86, was admitted to the hospita

QUEEN'S Hospital was said to have shown "gross failings in care" and "neglect" when an elderly patient died from infected bedsores after being twice left for 19 hours on an A&E trolley.

Parkinson's sufferer, Walter Gibson, 86, was admitted to the hospital from the Alexander Court nursing home in RainhamRoad, Dagenham, with a urinary tract infection at the beginning of December 2007, Walthamstow Coroner's Court heard last week.

Confused, bedbound and incontinent, the great-grandfather waited 19 hours - on a trolley designed to be used for a maximum of 12 hours - in the emergency department, before being moved to a bed.

By the time he returned to his care home, he had developed two significant pressure sores, as well as hardened, pre-ulcerated skin.


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When Mr Gibson again became unwell late on New Year's Day 2008, this time with pneumonia, he was once more admitted to an "extremely busy" Queen's A&E - where he endured another agonising 19-hour wait for a bed.

He was seen, seven hours after admission, by locum consultant physician Dr OA Elegbe, who discovered one sore had spread, worsened to a serious grade four ulcer - deep enough to expose tendon and bone - and had become infected.

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Although Mr Gibson's wounds were dressed, he was not moved to a ward and on to a pressure-relieving mattress for a further 12 hours.

Nor, said his family at the hearing, was he regularly turned to alleviate the painful and inflamed sores during that wait.

Coroner Dr Fiona Wilcox said: "It was quite clear the trolley was inadequate. In an ideal world a person like this should have been gone straight to a bed and nimbus [air] mattress."

Mr Gibson died on January 12, 2008, 11 days after admission, from septicemia as a result of the open bedsore wounds. Bronchial pneumonia was also found to be a contributing factor in his death.

Dr Elegbe, and a second expert witness, tissue viability nurse Beverley Wilson, both admitted there were "gross failings" in Mr Gibson's care.

Passing verdict Dr Wilcox said Mr Gibson died of "natural causes, contributed to by neglect".

She made provisional recommendations to Queen's Hospital to prevent repeat deaths including: increased bedsore training for nurses; increased risk assessment of patients likely to develop pressure sores; and increased numbers of available air mattresses.

A spokesman for Barking, Havering and Redbridge Hospitals Trust, said: "Over the past year, the trust in partnership with the PCTs has reviewed and streamlined the processes for patients attending A&E to ensure that they can be admitted and cared for in the right setting to meet individual needs.

"A list of recommended actions from the coroner will be submitted to the trust for implementation and response.

"The trust takes very seriously what lessons can be learned in order to prevent a similar occurrence in the future.

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