The family of a 31-year-old woman said that she was “abandoned” in a hospital corridor for hours before her death, an inquest was told.
Tamara Davis was said to be in her “most vulnerable moments” when she was left on a trolley in a hallway at Royal Sussex County Hospital for around 10 hours.
She died of multiple organ failure and sepsis caused by influenza – or flu – on Tuesday 13 December 2022.
Her sister Miya Davis told an inquest at Horsham Coroner’s Court that Ms Davis, from Brighton, was left “to fend for herself” as she suffered from diarrhoea and coughed up blood into a small bowl.
West Sussex and Brighton coroner Joanne Andrews concluded that Ms Davis died from natural causes and that there was no evidence that being placed in the hospital corridor contributed to her death.
However, the coroner expressed her “substantial concern” over the use of corridors and said she would be writing to Department of Health and NHS England over the ongoing problem in a prevention of future deaths report.
The inquest heard that Ms Davis’s partner Raphael Ifill had rushed her to hospital on Saturday 10 December after she had what was thought to be a bad cold for several days before collapsing at home.
Mr Ifill said that they were “left for hours” in the gangway and they kept asking what was happening.
Andrew Leonard, the consultant who saw Ms Davis, told the court: “Anyone being looked after in a corridor is concerning as it’s a failure of normal care process.”
Dr Leonard told the inquest the practice was becoming “increasingly the norm” across the country in the last few years, adding: “That is a tragedy.”
He added that it was a response to “overwhelming pressure on the system”.
The inquest was told that Ms Davis was in a resuscitation room until 5.30am on Sunday 11 December when she was moved to the corridor where up to 20 patients stayed throughout the day.
She was given one dose of antibiotics, fluids and paracetamol during her treatment and was moved out of the corridor to another cubicle at 3.20pm.
The inquest heard how her condition deteriorated and she was moved into intensive care later in the night on Sunday 11 December before she died on the morning of Tuesday 13 December.
Dr Leonard said that he had many “sleepless nights” over what happened to Ms Davis but added: “I still do not think we could have predicted what would happen to her.”
He said that he believed that Ms Davis, o Bromley Road, Brighton, had influenza and sepsis caused by the flu strain, which led to 10,000 hospital admissions during the 2022-23 flu season that year when the “majority” of young patients recovered in two to three days.
While Ms Davis was “diagnosable” with sepsis at 4.24pm on Sunday 11 December, she was not screened for the life-threatening condition until two hours later, the inquest heard.
However, Dr Leonard said that he was not sure that it would have made “any material difference to the outcome” if she was diagnosed earlier.
The inquest also heard from senior sister Alice Edmondson who was on shift that day and asked for Ms Davis to be moved out of the corridor.
The senior nurse described how the corridors are used every day and staff are allocated to work on the corridors where there is limited access to a toilet, it is overcrowded and there is a lack of privacy for the patient.
She said: “We would never move anyone to a corridor out of choice. Nobody should be nursed in the corridor.
“I really want the family to know that I, as a senior nurse, I feel upset everyday I go to work that people are in the corridor.”
The inquest was told that that having no patients in a corridor was a priority for the trust that runs the Brighton hospital.
After the conclusion, Mr Ifill said that the hospital “could have done more” and the duty of care was “absolutely shocking”.
He said: “We shouldn’t be changing bed sheets. We shouldn’t be carrying her to the toilet. She felt abandoned. She felt alone.
“If I fall sick in Brighton, I’ve got no faith to go to that hospital. It just feels really bad in there.”
Chief nurse at the University Hospitals Sussex NHS Foundation Trust, Maggie Davies, said: “We wish to extend our heartfelt condolences to Miss Davis’s family and friends.
“We entirely accept that the experience Tamara and her family had in the ED (Emergency Department) corridor before admission to intensive care fell short of the standards our patients and families should expect. That is a matter of deep regret and we are truly sorry.
“We also acknowledge the coroner’s concerns about the provision of corridor care and we are committed to working with partners to continue to try to resolve this issue for patients and families.”
What an absolute tragedy!!!
This place isn’t a hospital, it’s a death trap.
Why can’t someone deal with these fools
Richard, it’s not the staff’s fault or the management, we, were all clapping then a few years ago. It’s the funding for NHS is not right, also population of B& H has doubled in the last 20 years. With surrounding smaller hospitals closed down the pressure on Royal Sussex Hospital is awful. Condolences to her family and friends
Not their fault!! Why on earth are these doctors not diagnosing sepsis and providimg intravenous antibiotics urgently.
After all, the dangers of sepsis is plastered all over the side of the ambulance say call 999 immediately if you have the following symptoms.
You would be better off going down the vets rather than visiting this death trap.
No getting away from it any more, the NHS kills. And very expensively at that.
14 years of Tory neglect of the NHS
Don’t be silly. If you think this is all going to stop because labour are in charge you should think again. This is largely down to mismanagement and the poor medical abilities of medical staff to arrive at the correct diagnosis. We’ve seen this before and sadly we’ll see it again and again until someone addresses the shortcomings of these fools.
I agree with both you and John. Fourteen long years of destroying the NHS is not going to be undone anytime soon, by any government, because the problems are systematically ingrained.
I am sure it will improve under Labour. So what’s the plan let in millions more low skilled migrants in who pay no or little tax and treat them too with the limited resources the NHS has as well? Or does free Gear Keir and the Labour Party have a plan as record funding hasn’t worked.
The flaw in your argument today is that it hasn’t had record funding when you consider inflation and real terms rather than just raw figures.
All the hospitals are the same we are all terrified of going to them and as much if you don’t . I find it all very strange that since COVID everything is a billion times worse
14 years of increasing funding and 14 years of NHS mismanagement have brought us to this point.
Even Labour now say this is true.
Please do not keep repeating the mantra that the Tories ruined the NHS. There is a case to answer that they allowed it to happen, but they did not cause it. It has a high degree of autonomy.
It is now a bloated corrupt organisation, filled with waste, inefficiencies, undervalued and demoralised front-line staff and HR/Management that spend millions covering up and blaming staff for unnecessary deaths.
Yep, that sums it up. Management that really are out of their depth. Unfortunately people with seriously bad health have to rely on these clowns………what a bloody mess !!
John Donne. 14 years? Really?
In 1950, the population of the UK was 50 million. Now, it is 70 million.
A great number of that increase is the elderly, living longer, with the greatest demand.
The problem with the NHS is that it is regarded by governments to be sacred, untouchable, and so none have the balls to dismantle it and restructure it from being massively top-heavy and wasteful, because messing with it brings criticism by opposition parties and unpopularity with the public , simply because most of the public don’t understand what the real issue is. It needs to be a cross-party effort to fix it.
And it isn’t even about money, because when you look at the best health services around the world and compare what we spend, it’s plenty.
Starmer has pledged to restructure the NHS this time, but already he has put so many of his pledges into reverse, so he almost certainly will hope we’ve all forgotten about this one.
The NHS system was designed 80 years ago and has never been re-structured. At the very least, we need a £7 fee to see a GP to deter time-wasters. I know that may deter people who are genuine, but it is the lesser of the two evils.
To think the issue is 14 years old due to the Tories. Err.. No.
I think ChatGPT could not have made a less dispassionate statement compared to Chief Nurse Maggie.
I absolutely detest PR statements.
Agreed. They are meaningless. Moreover we have to pay for some unintelligent fool to dream up all this nonsense.
It took 90 mins to get an ambulance for my father suffering a stroke. There is also no choice as private emergency care is not an insurance option in this country due to the NHS. The NHS needs to go and just as in other countries should be based on an insurance based model where the private sector steps in.
Sorry to hear about your father. I agree that the NHS stifles all forms of private care. It is a poorly run state-funded monopoly, and there is a case that it would not be permitted by modern anti-trust/monopoly laws.
I guess that the ambulance had the pointless NHS advert on the side of it saying how important it is to get immediate treatment for suspected strokes.
A bigger load of garbage I’ve never read on here. For your info the NHS is awash with hived off private contracts done under the NHS label. They’re a big part of the problem as profits have to be made where.there are private interests. As for PFI don’t get me started. It may not be as true as it was that for what is forked out the NHS is good value for money compared to what people of other nations get, but the key problem is that we are way behind the better nations in terms of what we spend on, and invest in, healthcare. Tax the rich and the corporations to fund the NHS properly!
We are running out of rich people. 1 million of them pay over 40% of ALL government income. The truth is that we all need to pay more and use less. Or get better value for our money?
Really not true Chris, loads of examples of private aspects within the NHS. I’ll give you a big one. Pharmacies. They are all privately owned.
Yes pharmacies, dentists, GP surgeries and opticians. These were all private businesses before the NHS and remain so in England. However GPs and pharmacies really only have one customer in – the NHS. This rather skews any private market. They do not set their own prices, rather are told what the price is by the NHS. All are regulated. Pharmacies are closing and consolidating as a result of not being viable businesses in the face of increased costs. We already saw what happened in the dental world.
However my point stands. None of the above habitually spend millions (of our money) on excess management, out of and in-court settlements, legal fees, and spin doctors trying to game statistics.
I was recently taken to the RSCH via ambulance, it took about 20mins to come but when got to the hospital it took the ambulance crew 40mins before i could be handed over as the a&E was so busy. But they did not leave me to i was safely handed over. Loads of other ambulance crews were also being held up with handing patients over. This then results in patients having to wait much longer when they call a ambulance which must be costing many lives. The A&E is not fit for purpose. Can’t fault the staff there , they are working in very difficult circumstances.
Yeah, contract with RSCH is a 45 minute wait then go for ambulances. Want to speed up C2 call times, free up the hours spent waiting to handover at A&E.
What? Private emergency care not available due to the NHS? absolutely wrong. Private companies are not willing to provide it as it’s hugely costly, so instead cherry pick treatments to preserve profit
Private 999 ambulances go to the exact same work as NHS ambulances. The big difference is that the paramedics aren’t paid lower than a worker at McDonalds.
I recently used the RSCH A&E , it took 40mins for the ambulance to hand me over waiting in a corridor but they stayed with me all the time, once i was seen and tests taken and i was stabilized i was then put in a corridor for about six hours. The A&E was so busy room ran out in the corridor i was in with patients beds right next to each other.
I felt sorry for the A&E staff working in these conditions, the A&E dept is simply too small and dated not fit for purpose. The treatment i got from the staff was good. The Dept needs a area where arriving ambulances can wait with patients and a area where patients can wait on beds for results or waiting for a hospital bed to make it more dignified in your hour of need.
I did notice that a lot of patients were elderly i can only see this problem rising this winter if they have to live in cold homes. False economy cutting the help for some of the poorest elderly.
Don’t blame the hard working staff at the RSCH A&E they are working in outdated facilities that are not big enough for the patients they receive. Its a shame the dept was not included in the new build as it is falling apart.
I would like to thank the A&E staff for helping me as i’m on the mend.
The problem here is not having being held in a corridor but is the delay in the diagnosis of sepsis and the dismissal of her symptoms which led to the typical dose of paracetamol (you do not need A&E for that) and some oral antibiotics. When you have sepsis, each minute of delay in giving IV antibiotics decrease the chances of survival. The delay in this case amounted to multiple hours! The real question to ask is, how would have her probability of survival changed if the hospital had diagnosed sepsis and provided relevant care promptly? (And this question should be asked to an independent doctor possibly in an unrelated context to know the real answer)
My mother went in with aspirational pneumonia and was making progress and was on the mend they were shortstaffed. There was one nurse to the ward. And only one carer who actually told me after my mother had died drowned in her own fluid, that she laid my mother flat on the bed and tried to change her and It was a two man job to change my mum five minutes later she died. They also left my grandfather out in the Corridor he had gone in for a Leg operation and had to be brought back in and they left him and he died of pneumonia in the corridor and they didn’t even know he passed away . I knew Tamara she was a beautiful young lady and she went way too soon and I’m sorry that’s the fault of the Hospital and no one else
I know members of Tamara’s family and want to send my concolences to family and friends at this time. I have been to A&E and experienced ‘coridoor care’- the nurses and other staff were heroes, I will not forget them and clearly there are serious problems linked with funding and management. All, nhs staffs should be paid fairly and treated with care and respect. I have supported staffs taking industrial action and would do so again if they felt this was necessarry again. They are heroes, Thankyou all for all you have meant to me
Interesting developments in a similar case at Kettering hospital where the coroner has said that the untimely death following mistreatment and misdiagnosis went beyond human error and was tantamount to neglect. There is now a real possibility of criminal prosecution of the hospital and those persons involved.