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Paramedic failings 'contributed to Bristol meningitis death'

Published 12/08/2015

Lisa Armitage attempted to get medical care for her husband Mthuthuzeli Mpongwana
Lisa Armitage attempted to get medical care for her husband Mthuthuzeli Mpongwana

The failings of a paramedic "contributed" to the death of a man from meningitis after he waited six hours for an ambulance, a senior coroner said.

Mthuthuzeli Mpongwana, 38, died in hospital two days after his wife, Lisa Armitage, 28, called the medical advice number 111 at 10.30pm on January 5.

A call handler told Ms Armitage her husband may have meningitis after hearing he was suffering from a headache, sore neck, fever and struggled to look at light.

Ms Armitage was instructed to wait outside their home in Bedminster, Bristol, as a rapid response vehicle with blue lights on would be there shortly.

Paramedic Dana Noriega did not arrive until 1.17am.

He initially dismissed Mr Mpongwana's symptoms as "man flu" and said he did not require hospital treatment.

The paramedic took a series of observations - failing to spot that Mr Mpongwana had signs of sepsis and meningitis - and downgraded the case to a 40 minute-response at 1.50am.

Maria Voisin, senior coroner for Avon, said Mr Noriega should have immediately requested a high-priority ambulance, which required a 15-minute response.

Mr Noriega did not request such an ambulance until 3.50am, by which time Mr Mpongwana's condition had badly deteriorated.

He should also have given Mr Mpongwana penicillin as quickly as possible, but only did so at 3.30am - 20 minutes after he was advised to do so by a GP.

Mr Mpongwana was unable to stand, delirious and incontinent when an ambulance finally arrived to take him to Bristol Royal Infirmary at 4.20am.

His life support was withdrawn at 12.30pm the following day, January 7, after consultants found a brain injury he had suffered was non-survivable.

Ms Voisin said: "Mr Mpongwana died from natural causes contributed to by a failure to take appropriate action in the face of an obvious need.

"That failure was at 1.50am on January 6, when a P1 (high priority ambulance) backup should have been requested and benzlpenicillin should have been administered.

"The inappropriate care that was given resulted in a missed opportunity for medical treatment."

Mr Noriega's contract was later terminated by South Western Ambulance Service NHS Foundation Trust (SWAS).

In interview with the trust following the tragedy, Mr Noriega described Mr Mpongwana's condition as "typical man flu", the coroner added.

Dr Dan Freshwater-Turner told the inquest the outcome may have been different if Mr Mpongwana had received penicillin and hospital treatment sooner.

The consultant, who treated Mr Mpongwana before his death, said: "We will always advise giving antibiotics as early as possible.

"It is possible if he had had treatment earlier that the outcome may have been different."

In a statement read to the inquest, Ms Armitage said she told Mr Noriega her husband had a severe headache, stiff neck and sore limbs.

"I remember that the paramedic took my husband's blood pressure before telling me my husband had man flu and didn't have to go to A&E," she said.

"I was under the impression he thought my call had been a waste of time."

Mr Noriega claimed he recognised Mr Mpongwana's symptoms were "red flags" for meningitis and required hospital treatment.

He admitted to being "exhausted" at the time of the tragedy, having worked the busy Christmas and new year period.

The paramedic said he had been told it was "too busy" for an ambulance to attend to Mr Mpongwana on his way to him.

He claimed to have downgraded the call from a priority two call to a priory three call to "buck the system" and widen the remit for available vehicles.

"They said everybody was committed," he said. "I tried to think outside the box until they sent someone down."

Mr Noriega admitted that was "the wrong decision" and "taking a risk", following questioning by Ms Voisin.

He left the inquest immediately after giving evidence and did not return to hear her conclusion.

Speaking after the inquest, Ms Armitage said she was "baffled" by the care given to her husband.

"I am extremely concerned about the treatment he received by the ambulance staff and I was baffled at the time that they didn't seem to be taking into consideration his symptoms and the urgency of the situation," she said.

"It is incredibly well known that you have to act quickly if someone starts to suffer from symptoms of meningitis, and his death could have been avoided if they had taken the care and attention to give him the medical care he rightly deserved."

Julie Lewis, a partner at Irwin Mitchell, represented Ms Armitage at the inquest.

She said Mr Mpongwana's family wanted assurances that all staff at SWAS are fully trained to notice and diagnose the signs of meningitis.

A serious incident report following the death found Mr Noriega was not familiar with guidelines for recognising and treating sepsis and meningitis.

A spokesman for the Trust said it was "very sorry for the unacceptable delays Mr Mpongwana suffered".

He said a number of improvements had been made and Mr Noriega's contract had been terminated.

"We would like to offer our sincere apologies to Mr Mpongwana's family," he added.

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