A hospital's intensive care department delayed admitting a student who was in multiple organ failure with sepsis, a court heard.
An inquest into the death of Hackney student William Hewes heard that an emergency department registrar felt she was not being taken seriously when she sought intensive care input, after he was rushed into Homerton Hospital with meningitis.
Bow Coroner’s Court had already heard that a miscommunication between a doctor and nurses meant William – who died of sepsis later that day – did not receive antibiotics when he should have done.
Barrister Neil Sheldon KC, representing William's family, suggested to the court that he had also not been admitted to intensive care as urgently as he could have been.
An intensive care doctor visited William’s bedside at 1.09am for four minutes, the court heard, but declined to admit him, saying they wanted to see how he would respond to the treatment he was receiving in the emergency department.
They left, giving no indication as to when they would return, said Dr Rebecca McMillan, the doctor in charge of the emergency department that night.
The inquest on Thursday (February 13) had earlier heard William was admitted to Homerton Hospital at around 12am on January 21, 2023 with a headache, bad pain in his side, a rash and vomiting.
Dr McMillan told the court she immediately assessed his condition as life-threatening and formed the view he had meningococcal sepsis.
Dr Luke Lake, an emergency department registrar, said he had expected the intensive care doctor to come back "urgently" after calling them twice in ten minutes to express his concerns over William's deteriorating condition.
He described William has having "significant acute kidney injury" by that point and failing eyesight.
He placed his calls at 1.50am and 2am.
Around half an hour later, Dr McMillan also called for the intensive care doctor to come back and reconsider.
But she said the response was so non-committal that nurse in charge Luke Brown had to also call, to stress the urgency of the situation.
“If I’m recalling correctly, Luke was stood next to me for part of the [phone] conversation and I think he picked up that I repeated multiple pieces of information several times and picked up on the general tone of the conversation,” Dr McMillan testified.
“It was clear that she was coming back,” she clarified to the court. “But I was left with the impression that she wasn’t behaving with the same urgency that I was conveying things with… I was concerned about the timeliness.”
Dr McMillan told the court William was now so ill he required blood pressure support that could only be delivered by intensive care.
He had also become dependent on oxygen support and his urine output was so low that she felt his kidneys were “failing”, so he needed “renal replacement”.
The intensive care doctor eventually arrived at around 3am.
Dr Lake told the court it was he who had uncovered the earlier mistake over the antibiotics.
He had been told by Dr McMillan that William had received them, but after spotting there was nothing on the computer to reflect that, he went to check.
“I said, ‘Has William been given antibiotics?’” he testified. “[Dr McMillan] replied that she thought he had received antibiotics.
“But just at that point, staff nurse [Marianela] Balatico appeared and Dr McMillan, as I recall, turned to her and said, ‘William has received antibiotics, hasn’t he?’
“She said, ‘No, he hasn’t, because they haven’t been prescribed'.”
Dr McMillan had earlier testified that she was at a desk with Nurse Balatico and another nurse, Matthew Potts, when she told them both which antibiotics William needed to be given.
“On reflection, I can’t have been clear because I know that if one of the two of the thought that was a direct instruction to them, that they would have done it,” Dr McMillan had admitted.
Quizzed about whether she had “frequently” issued instructions “to the room at large”, Dr McMillan responded: “Absolutely not.”
“It’s not something I would ever knowingly do or deliberately do and it’s obviously something that happened that day,” she said.
“I don’t believe it’s my common practice and I didn’t think it had been my practice on this day. It’s not something I realised I had done at the time.”
She added: “I wouldn’t have left without thinking that they were being given. At the time I thought I had made myself clear.”
“I felt that the information I was passing on was adequate enough for her to have all the information she needed,” Dr McMillan testified.
The inquest continues.
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