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Phillip Gower from Novum Law’s Cardiff office recently represented the parents of 22-year-old woman Demi Reed, who tragically died after hospital failings at the Royal Gwent Hospital in Newport on 10 April 2020 following an overdose of prescription drugs.
At the inquest at Gwent Coroner’s Court, Assistant Coroner Naomi Rees heavily criticised hospital failings which meant doctors failed to properly assess Demi on her admission to the hospital and failed to give her blood tests for over 24 hours. Had Demi been given the appropriate blood tests, the hospital would have picked up that Demi had taken a paracetamol overdose and been able to save her life.
Demi, who worked full time at Hydro Aluminium in Bedwas, Caerphilly had become utterly consumed by the terrible consequences of a fatal road traffic accident that involved her boyfriend in early April 2020 in the M4 Brynglas Tunnel.
Although Demi herself was not involved in the collision, she completely blamed herself for not preventing the accident having spoken to her boyfriend shortly before it happened. She took an overdose which led to her admission to the Royal Gwent Hospital on 5 April 2020 and was then subsequently discharged.
Assistant Coroner Naomi Rees found that Demi was ‘in crisis’ and that she had taken a number of other overdoses within the following 72-hour period which led to her final admission to hospital on 8 April 2020.
At this time, Demi told staff she had taken an overdose of paracetamol and this was recorded in her hospital notes on admission. However, owing to an error in the hospital computer system, Demi was not assessed by a doctor.
Shockingly, Demi was actually given paracetamol by hospital staff on three separate occasions, despite having taken a paracetamol overdose.
The Coroner recorded a narrative conclusion which found that blood tests should have been taken within an hour or so of her admission which would have shown that Demi had very high levels of paracetamol in her body. She would then have been given an intravenous antidote (NAC) shortly thereafter, which would have prevented liver damage and saved her life.
Dr David Hepburn, a Consultant Anaesthetist and Intensivist who gave evidence at the inquest confirmed that the antidote would have been extremely effective if it had been given within eight hours and would have saved her life. However, by the time he was involved in her treatment a few hours before she died, the poisonous effects of the overdose could not be reversed.
Demi’s cause of death was given as “multi-organ failure caused by paracetamol overdose.”
Very sadly, Demi died alone in the hospital without her parents at her bedside due to COVID restrictions that prohibited their attendance.
“Tragically in my clients’ case, Demi’s dangerously high levels of paracetamol in her body went completely undetected by Royal Gwent Hospital resulting in her not receiving the emergency treatment she needed to save her life.
“The Coroner also found that Demi’s mental health was not adequately explored by Mental Health Services who had been made aware of her case. This was despite the inescapable risk of harm which increased with each of her hospital admissions. This tragedy was entirely preventable.”
Read Wales Online’s coverage of this case here.