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13 March 2012, 16:00
A teenager, who was sent home of a Leeds hospital four days before he died from a haemorrhage, could have been saved if he had been admitted as an inpatient, a coroner said today.
15 year old Jacob Long, 15, from Rawdon, in Leeds, died in May 2009 after a vein near his heart ruptured, possibly as a result of an undetected genetic syndrome.
He was sent to the Leeds General Infirmary (LGI) after suffering from a sudden pain in his chest and a swelling in his neck the size of half a tennis ball but was later discharged.
Recording a narrative verdict at the inquest into Jacob's death at Wakefield Coroner's Court today, coroner David Hinchliff said: “Had Jacob been an inpatient at the time of his catastrophic bleed on 25 May 2009, his chances of successful resuscitation and survival would have been greater.”
The coroner said: “Leeds is the largest teaching hospital in England. Leeds, I am told, is the second largest city in the country. An institution of that size ought to have permanent consultant cover in its accident and emergency department.”
Mr Hinchliff told the inquest how Jacob went to the minor injuries unit at Wharfedale General Hospital, in Otley, on 20 May 2009 after coughing and experiencing pain in his neck and chest.
He had a large, black swelling to the right side of his neck, measuring 15cm by 10cm and had low blood pressure.
A doctor said Jacob was suffering from bleeding in the chest and sent him to LGI, who knew he was coming.
But after arriving, Mr Hinchliff said there were a “cumulative series of missed windows of opportunity”.
He said these included Jacob not being prioritised when he reached the hospital; being prescribed painkillers by a junior doctor without medical review; and only having one further blood pressure check at the hospital.
Jacob and his grandfather, who was with him at the hospital, were also not given any advice about symptoms to look out for after he was discharged on 21 May.
Four days later, the teenager collapsed at his grandparents' home and was rushed to the LGI, where he was pronounced dead.
He died from a spontaneous rupture to a vein near his heart, resulting in haemorrhage.