Extra funds for hospital that 'lost' heart patient: Publicity 'led to award of pounds 140,000'

AN NHS TRUST is being bailed out by the NHS management executive to the tune of pounds 140,000 after it 'lost', for four hours, an 89-year- old woman who died of a heart attack after being taken to its accident and emergency department.

The money is being found after an inquiry, published yesterday, found that under-staffing at Greenwich Healthcare Trust, in south- east London, played a large part in the incident.

But Ian Paterson, secretary to the inquiry, said yesterday that Greenwich was far from unique in the 'enormous pressure' it was under.

'You will find similar incidents to this occurring regularly in accident and emergency departments all over the country,' Mr Paterson said. Two- to three-hour waits were common and the extra cash had been funnelled down from the management executive because, 'after this experience, it cannot be tolerated in Greenwich. But you know very well it does happen elsewhere.' The money had been provided, he said, 'because there has been a lot of publicity around this'.

The inquiry is critical of many details about the way the accident and emergency department has been run at Greenwich, and of the leadership and organisation provided by the consultant in charge of its casualty department. The hospital said he had been on sick leave since the inquiry started.

It found the chain of events leading to Elsie Westron's death started with a GP failing to diagnose her heart attack, but referring her to hospital on 1 September last year. She arrived at 4.07pm, but the Acute Care Area was full, so Mrs Westron was put into a treatment room. A junior doctor was called and a nurse took her observations but was under 'extreme pressure' and was too busy to do the electro- cardiogram which would have revealed the heart attack.

The unit was two nurses short, every bed and bay was full, casualty was 'crowded' with members of the public 'behaving badly and threatening staff' in an attempt to jump the queue, while the two doctors involved were both junior and newly appointed. One was just four weeks into his first appointment and had not been properly familiarised with the casualty department's procedures, while the senior house officer (SHO) - the second most junior rank of hospital doctor - was also running a medical ward. No registrar or higher rank doctor was part of the on-call team.

When the SHO reached casualty at about 4.30pm he had, in Mr Paterson's words, 'to save the lives of three patients with life-threatening conditions', so Mrs Westron, in a separate room though under nurse observation, was overlooked. Almost two hours later, the doctor, who had had to return to the ward, approved her transfer to a ward without having seen her.

She died at 7.30pm from her heart attack without having been seen by a doctor.

The department is staffed by a consultant, who is criticised in the report for failing to agree consultant cover when off duty and for losing contact when on-call, together with seven senior house officers who are under such pressure that the report says they have to carry bleeps when on study leave.

Bruce Joyce, chief executive of the hospital - and formerly the general manager of the health authority which ran it, said that after talks with the management executive and the trust's purchasing authority, an extra pounds 140,000 a year was being made available to recruit a second consultant, two registrars and two extra nurses.

Asked whether a cynic would say that Elsie Westron's death had brought the hospital pounds 140,000 that it had plainly needed all along, Mr Joyce said: 'A real cynic could say that.'