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Shortage of neurologists at Whipps Cross Hospital creates risk of future deaths, coroner warns

A lack of available specialist neurologists at Whipps Cross University Hospital in Waltham Forest creates the risk of future patient deaths a London coroner has warned. He has also raised concerns about periods where there are no on call specialists available at the hospital and long waiting times for outpatient consultations.

A Prevention of Future Deaths report by Assistant Coroner for Inner London North, Richard Brittain has been sent to Barts NHS Trust who is responsible for Whipps Cross. In the report, the coroner gives the Trust until 17 June to respond to his concerns by outlining what action it has taken or will take, along with a timetable.

The report follows the inquest in April into the death of 51-year old mother of four from Chingford, Marina Fagan, who died from a rare neurological condition, Posterior Reversable Encephalopathy Syndrome (PRES) that went undiagnosed for 13 days, despite numerous consultations and trips to hospital.

The inquest, held at St Pancras Coroner’s Court on 22 April, heard that Mrs Fagan, who had a family history of aneurism, was admitted to Whipps Cross on 17 September 2015 for two days after suffering severe headaches. Investigations ruled out a brain haemorrhage so she was discharged from hospital on 19 September but later that day returned to Accident and Emergency as her headache persisted. Again, a neurological examination showed no abnormalities and a recommendation was made that her GP refer her to the hospital’s neurology outpatients’ unit.

She was referred on 24 September but attended Whipps Cross again the next day due to continued headache symptoms. She began to become confused but it was not until 29 September that a clinical review found she had loss of vision and problems moving her eyes. Finally, on 30 September an MRI scan showed she had PRES and despite supportive treatment, she died on 6 October 2015.

The inquest heard evidence from the neurologist who eventually treated Mrs Fagan that given her symptoms, he would have expected to have been involved in her care at an earlier stage and that an MRI scan should have been requested on 19 September. He also stated that input from a neurologist should have been requested after Mrs Fagan developed confusion on 26 September and that an MRI should have been undertaken. He raised concerns that locally, there are insufficient neurologists to provide specialist care and that none were on-call at the time of Mrs Fagan’s initial admission to hospital.

The neurologist’s concerns were echoed by Mrs Fagan’s GP who explained that the current waiting time to see a neurologist in the outpatient unit is 72 days.

The coroner concluded that although Mrs Fagan died from PRES, a condition that would not have been treatable, it could have been diagnosed earlier.

The family of Mrs Fagan were represented by Andrew Harrison a partner in the medical negligence team at London law firm, Hodge Jones & Allen, who says: “Mrs Fagan’s family are hugely concerned about the time it took the hospital to diagnose such a severe and life-threatening condition.

“Mrs Fagan continually presented at Whipps Cross with extreme and persistent headaches and yet she was not seen by a specialist neurologist or given an MRI scan. It is clear from the coroner’s Prevention of Future Deaths report that her case raises significant concerns about the shortage of neurologist cover in the Waltham Forest area. It is hoped that Barts NHS Trust will take immediate steps to address this serious issue.”