Coroner says Mary Muldowney probably would have survived if she had been operated on immediately for bleed on brain

A woman died from a brain haemorrhage after at least three hospitals refused to admit her for surgery because they had no intensive care beds.

In a case that brings the deepening NHS bed crisis into sharp relief, a coroner said it was likely that Mary Muldowney, 57, would have survived if she had been given immediate surgery to stem the bleeding.



Muldowney was admitted to East Surrey hospital in Redhill on 20 July last year and immediately diagnosed with a suspected bleed on the brain.



When a CT scan carried out just over an hour later showed heavy bleeds, doctors requested an immediate transfer to a specialist neurosurgical unit for surgery.



But three units – St George’s hospital in Tooting, south-west London, the Royal Sussex county hospital in Brighton, and King’s College hospital in London – refused the request because they had no beds. The coroner heard that other hospitals had been contacted but also had no beds available.



The Royal London hospital (RLH) agreed to take Muldowney after a consultant neurosurgeon was contacted by a former colleague at the East Surrey hospital but her condition deteriorated in the ambulance and surgery could not save her.

The death will put further pressure on the government to address a growing crisis after leaked figures suggested that A&E patients in England experienced the worst month of delays in January since a four-hour waiting target was introduced 13 years ago.

It also comes after the heads of the Royal College of Surgeons (RCS) and NHS Providers said that surgeons were “kicking their heels” because of delays to operations caused by a shortage of beds.



In a letter to the Sunday Times, Clare Marx, the president of the R CS, and Chris Hopson, the chief executive of NHS Providers, blamed cuts aimed at driving productivity for causing greater inefficiency in some areas. They added that bed occupancy should not exceed 85% for safety reasons, but overnight inpatient beds were routinely 89% occupied.



In a letter to bosses at NHS England, first reported by the Health Service Journal, the inner north London coroner, Mary Hassell, said a consultant neurosurgeon at the RLH, had accepted transfer of Muldowney immediately, “though in fact the RLH had no intensive care bed available at that time”.

After being admitted to hospital Muldowney had woken briefly at 1pm and interacted with her daughter. She was transferred to the RLH and taken straight to theatre at 4.40pm. But the coroner wrote: “Unfortunately, her pupils had become fixed and dilated in the ambulance during transfer to the RLH and surgery did not save her. If she had been transferred promptly, it probably would have.”



The coroner, who recorded a narrative verdict, said evidence showed that Muldowney “could have been transferred, undergone surgery, spent time in recovery, and then an intensive care bed procured”.

If a bed could not be found she “could then have been transferred to a different hospital, at least having undergone the time-critical clot evacuation and aneurysm clipping”, she wrote.

She added: “With prompt transfer and surgery, Ms Muldowney would probably have survived. In my opinion, action should be taken to prevent future deaths and I believe that you have the power to take such action.”



Responding, NHS England’s medical director, Sir Bruce Keogh, said a serious patient safety issue had been raised and he was “very sorry” to read of Muldowney’s death.



He said Prof Simon Mackenzie, from St George’s hospital, had suggested Muldowney “was not deemed by the neurosurgical services to which she was being referred to require immediate life-saving surgery” and fell outside the scope of the universal acceptance policy.



Mackenzie said he believed St George’s had provided acceptable care because Muldowney suffered a re-bleed during the ambulance transfer to the RLH.



Mackenzie said that “although at the time of the referral to the St George’s neurosurgical unit a re-bleed was a possibility, this was not the reason for her urgent transfer”, Keogh wrote. The process of securing a bed added a delay of just less than two hours to the acceptance process, he said.

Keogh said clinicians from East Surrey hospital and St George’s were due to meet as there was a clear “difference in perspective” between them about how the surgery had occurred.