Family challenges hospital over death of “caring” nurse after A&E discharge

Friday 07 October 2022

The family of a “happy and caring” nurse who died shortly after being discharged from A&E two years ago have expressed their concerns that the hospital has not learnt from the tragedy.

Carole Isherwood (54), who was remembered by loved ones as “kind and generous” and someone who “would help anyone” died after fatally hitting her head on the pavement in town while walking home from Accident and Emergency in 2020.

In an inquest to understand the reasons behind her death held yesterday, Ms Isherwood's family raised questions about the standard of her care while in the General Hospital, asking if she should have been discharged and allowed to walk home alone despite having collapsed at work earlier that morning.

While she was described as an "enthusiastic" nurse who "loved her job", Ms Isherwood's family said her mental health started to decline after an incident when she was working in the General Hospital, after which she stopped working there.

Her mental health subsequently deteriorated, and she was supported by Drug and Alcohol Services. The inquest heard that she found a new job which made her "happy" and she "seemed like her old self again". However, the loss of her father in 2019 proved a "huge setback" and her family feared that she had begun drinking to help her cope again.

On the morning of Monday 27 July 2020, Ms Isherwood collapsed at L'Hermitage Care Home where she was working, with some colleagues having reported smelling alcohol on her. An ambulance was called and she was taken to A&E for assessment.

It was recorded that she seemed "medically well" with "no signs of pain". Her ECG results came back as normal and she was subsequently discharged.

She left the hospital to return home on foot, but shortly collapsed on the high street, hitting the back of her head on the pavement.

Ms Isherwood was tended to by an off-duty paramedic until the ambulance arrived and she was taken back to hospital.

Upon readmission, she was reported as initially seeming fine, but sadly quickly deteriorated. A CT scan showed that she had suffered an "extensive" bleed on the brain, and was sent to Southampton Hospital, where she was referred for neurosurgery. However, the inquest was told that it was ultimately decided that she should not be transferred due to her "poor prognosis", and she passed away in the ICU on Wednesday afternoon.

Appearing at yesterday's inquest via video link the UK, Ms Isherwood's younger sister Helen Jepson suggested that "[Ms Isherwood's] care fell below what she should have reasonably expected to receive" during her first admission to A&E.

Pictured: At the inquest, Ms Isherwood's sister suggested that “Carole’s care fell below what she should have reasonably expected to receive” during her time at A&E.

As a nurse herself, Ms Jepson said she had reviewed the notes from her sister's initial time in A&E and noted that there were comments about her observations being normal, but she could not find the observation charts.

She also noted that bloods were taken from her sister when she was triaged in A&E, but these were not reviewed before she was discharged. 

Had the bloods been reviewed, it would have shown that Ms Isherwood's blood alcohol level was 299mg/dL, which is almost four times the legal driving limit, it was pointed out during the inquest.

“Is there a chance that a different outcome might have prevailed if this had been known?” Ms Jepson asked.

She also queried if anyone in the hospital had checked if her sister could get home safely or if there was someone waiting for her there. She added that Ms Isherwood's flat is located up four flights of stairs and there was no documentation about her mobility and safety to leave the hospital.

Answering those queries via letter, Dr Nicola Charles (Acting Consultant and Clinical Lead in the A&E Department) agreed that she could not find the observation chart from Ms Isherwood's first admission to A&E but said that there was evidence of three sets of observations from the ambulance which were normal. 

She also agreed that there is no documentation to suggest that Ms Isherwood's blood tests were looked at prior to her discharge, but explained that “we do not generally keep people in hospital due to their blood alcohol level”.

She added that Ms Isherwood's “raised ethanol level is surprising” as she said she hadn’t been drinking that morning and was at work at that time at her collapse.

Dr Charles suggested that Ms Isherwood was rightfully discharged by the Consultant after her ECG results were normal and reiterated that “even if the alcohol level was available, she would’ve been discharged anyway as she seemed fine”.

However, she did suggest that “in hindsight” it would have been appropriate to check if someone could come to collect Ms Isherwood if her raised blood alcohol levels had been known.

Ms Jepson then expressed that the six-month delay in receiving a reply to her initial letter made her even more “anxious and concerned” and added that the comment about “hindsight” made her “angry” and “upset”. 

She added that her “confidence in the hospital’s competency has been damaged” and asked why her sister’s discharge was so urgent after she had only spent 41 minutes in A&E, suggesting that it was “more expedient than caring”.

A further written response was jointly issued from Dr Charles and Dr Nicholas Payne, a Consultant in Emergency Medicine, which explained that a person’s blood alcohol level can vary depending on a huge number of factors and are therefore not used as a standard for discharge. 

The letter concluded that, as she was “fully alert and orientated”, there was “no compelling reason why [Ms Isherwood] be kept for a period of observation” during her first admission to A&E.

Dr Payne was also present to answer any further questions in person. When asked by Ms Isherwood's family what is going to change for the next person to come into A&E, he explained that there “will be no changes in the department in light of this particular case”.

He said: “If someone is alert and orientated and able to walk, then they will be dismissed, and if somebody is intoxicated and unable to stand then they will be kept. That will not change.”

Dr Payne added that there had been no formal mortality or morbidity meeting about Ms Isherwood's case, explaining: “We don’t review all our deaths.” 

Ms Isherwood's family said: “It does concern us that someone can be discharged from the A&E department and it result in their death, but the hospital does not seemed to have looked into this or learnt from it."

Tributes were paid to Ms Isherwood's character during the inquest, and it was noted that her organs were donated. Her partner of 28 years, Alan ‘Barney’ Clark, described it as “fitting that she has continued to help people even after her death”.

The inquest concluded with Deputy Viscount Advocate Mark Harris, acting as Coroner, describing her as a “lovely” and “kind” person”, who was “even caring and generous in her death through organ donation, which is to be commended."