A teenager with type 1 diabetes died just hours after a GP told her she only had an ear infection.

Rosie Umney, 15, was at school when she fell seriously ill on the afternoon of July 2, 2018 and her granddad Michael Umney was called to the school to take her home.

When she was taken home, Rosie began to feel better so Mr Umney left her with her mother, Georgina Umney, once she had come from work.

Rosie Umney, 15, was at school when she fell seriously ill on the afternoon of July 2, 2018 and her granddad Michael Umney was called to the school to take her home (Picture: BPM Media)

An inquest at Canterbury Magistrates’ Court heard how Mr Umney returned to Rosie’s house at 5.30pm that evening because Rosie was again feeling very unwell.




When he arrived, his granddaughter was hyperventilating and she told him she had a terrible pain in her side.

She had been sick and told her grandfather she had reflux, which he had never previously known her to have experienced.

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Although Mrs Umney had booked a doctor’s appointment for Rosie the following morning, they decided to book an emergency appointment at William Street Surgery.

Once there, Rosie was examined by Dr Sadaf Mangi and Rosie’s mother and grandfather told her they had taken Rosie’s blood glucose reading on her machine and it said the results were normal.

After examining her, and finding she had a heart rate of 140 beats per minute, Dr Mangi told Rosie that she was suffering from an ear infection and gave her a prescription for some medicines.

Mr Umney said: ‘I was amazed because I was sure she was going to say to go to hospital. I said to Georgia I didn’t feel happy about what Dr Mangi had diagnosed.’

He added that even when back at home, Rosie was still hyperventilating.

Rosie’s blood glucose levels were found to be ‘normal’ on her machine but when paramedics measured it, it was ‘high’ (Picture: BPM Media)

Rosie’s father, Lee Hubble, gave Rosie Calpol and it was heard that after taking this, her temperature recovered somewhat.

Because it was a hot night, Rosie and her mother decided to sleep on the settees in the lounge.

Mr Hubble said at around 1am he woke to give Rosie her medication but Mrs Ungey had already given it to her. After going to bed, he said he heard a ‘thump, thump’ sound and his wife calling out.

When he went to the living room, Rosie was on the floor.

A paramedic was called and once they arrived, at around 1.10am, they took over CPR from Mr Hubble.

One of the paramedics twice tested Rosie’s blood glucose levels on his machine and found a reading of ‘high’, indicating it was more than 30 mmol/L.

When he then tested her levels on her own machine, she was found to have a ‘normal’ reading of 8.3.

A test with another paramedic crew’s machine also found that she had a high reading, which the paramedic accepted was a sign Rosie’s machine was giving incorrect readings.



Rosie was rushed to hospital but despite the best efforts of the medical staff, she tragically died.

Her granddad, who had been called to Rosie’s home in the early hours of the morning, arrived there to find a number of paramedics working on her.

He stayed with Rosie’s brother and sister at the home until everybody else left.

Rosie died of diabetic ketoacidosis, a condition caused by consistently high blood sugar levels (Picture: Google)

He only found out his granddaughter had died when he overheard someone say on a police radio that the ‘little girl has died’.

Speaking at the inquest, Mr Umney said: ‘I still blame myself for her death as it was my decision to take her to the doctor’s and not to the A&E.’

A post-mortem found that Rosie died of diabetic ketoacidosis, a condition caused by consistently high blood sugar levels.

Speaking during the inquest, Dr Mangi accepted that she did not know the advised procedure in terms of warning signs and action to take in the case of children who may be suffering from type 1 diabetes.

These guidelines highlight a number of symptoms, including vomiting, shortness of breath and temperature, which if found in a diabetic child, should lead to them immediately being taken to hospital.

She said that while diabetic ketoacidosis had been her initial thought, she discarded this idea completely when Mrs Umney said Rosie’s blood glucose readings were normal and attributed her symptoms to the infections, and her increased heart rate to her sense of anxiety, itself drawn from the infection.

She also said she could not remember Rosie having to be carried into the room.


When asked during the inquest by the family’s representative, Rory Badenoch, Dr Mangi accepted that she should have been aware of these guidelines.

In a statement to the family, Dr Mangi said: ‘I wanted to pass my condolences and apologise to the familyof Rosie Ungey. I would like to say to the family I deeply regret I fell short of my responsibilities as a GP. I whole-heartedly apologise.’

Dr Peter Wilson, a GP clinical advisor with NHS England, said he found a number of issues with Dr Mangi’s actions based on her notes, including her failure to record Rosie’s respiratory rate or take blood pressure and that she recorded a very high pulse rate without making any further comment.

While he stated in his opinion, that Rosie would have had a ‘much better’ chance of living if she had been sent to hospital immediately after visiting the GP, it was noted he is not an expert in the topic of paediatric diabetes.

Assistant coroner James Dillon, who oversaw the inquest, adjourned it until a later date and ordered a report to be made before it resumes.

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