NHS rules student died after being denied in-person appointment

Law student, 26, died after wrongly being denied a face-to-face appointment with his GP, NHS officials say

  • David Nash had four calls with GP surgery but was denied in-person consultation
  • He was suffering excruciating ear pain and died within days from a brain abscess
  • NHS probe into his death found that F2F appointment ‘should have been offered’

The family of the law student believe he would not have died if he had been seen face-to-face by a GP

A law student died after wrongly being denied a face-to-face GP appointment, the NHS has admitted.

David Nash, 26, from Nantwich in Cheshire, had four phone appointments with GPs and nurses between October and November 2020.

He was denied an in-person consultation, despite telling practice staff that he was suffering excruciating ear and neck pain and slurring his words.

Mr Nash tested negative for Covid on the same day he was finally due a face-to-face appointment, only for it to be cancelled anyway. 

Medics told him to re-test and prescribed him painkillers, in what one GP described as ‘a breach of duty’. 

He died from a brain abscess two days after his last contact with his GP surgery. Relatives say it was triggered by an ear infection.

An internal NHS England probe into Mr Nash’s death concluded that ‘a face-to-face assessment should have been offered or organised’.

Mr Nash’s parents, who are convinced he would be alive if he was seen in-person, have spoken out about the ‘appalling care’ their son received, accusing the health service of ‘completely’ letting him down. 

David Nash, 26, (pictured) had four remote consultations with doctors and nurses at a Leeds GP practice over a 19-day period before he died from a brain abscess on November 4, 2020

Mastoiditis is a serious bacterial infection that affects the mastoid bone behind the ear.

Most people with mastoiditis recover quickly and have no complications as long as the condition is diagnosed and treated quickly.

Its symptoms include redness, tenderness and pain behind the ear, swelling behind the ear that causes it to stick out and discharge from the ear.

Sufferers may also have a high temperature, a headache and hearing loss.

They are advised to see a GP as soon as possible if they have symptoms or an ear infection that does not get better with treatment.

The infection develops if the mastoid cells become infected or inflamed, often following persistent middle ear infections.

Cholesteatoma can also cause mastoiditis. This is an abnormal collection of skin cells inside the ear which may prevent the ear draining properly, leading to infection.

GPs need to examine the inside of the ear and refer a patient to a ear, nose and throat specialist for further tests for mastoiditis to be diagnosed.

This usually includes a blood test and testing discharge from the ear for a bacterial infection. 

Mastoiditis should be diagnosed and treated quickly with antibiotics.

Surgery may be required in severe cases to drain the middle ear or remove part of the mastoid bone. 

Although most people with mastoiditis do not experience serious complications, treatment is not always easy and the infection may come back. 

If the mastoid bone is severely infected and is not removed, it can cause hearing loss and life-threatening health complications such as a blood clot, meningitis and a brain abscess.

Source: NHS 

Mr Nash had been in touch with his surgery on four occasions between October 14 and November 2 2020.

Recordings of his four calls were obtained by BBC Newsnight and will be broadcast tonight, with the permission of his family. 

They reveal that he was due to be seen at his surgery for a blood test on the day of his fourth and final call to his GP.

Mr Nash, who was studying law at the University of Leeds, told of debilitating neck pain and was slurring his words.

He told a nurse: ‘Pretty much every time my heart beats I’m getting these pains.’

Mr Nash had tested negative for the coronavirus on a gold-standard PCR test, which was being carried by an estimated around 600,000 people in England at the time.

But the nurse cancelled his appointment for later that day and asked him to test again before coming to the surgery.

He was prescribed codeine for his neck pain.

That same day, after five calls to NHS 111, Mr Nash was taken to hospital in an ambulance. 

He died at at Leeds General Infirmary November 4 from brain abcess, his family say. Relatives last year said he also had meningitis at the time of this death.

The NHS, which launched an investigation into his death, found that ‘the overarching benefit was less than the risk with going ahead with blood tests’. 

According to a finding seen by Newsnight, it said: ‘A face-to-face assessment should have been offered or organised to confirm the diagnosis and initiate definitive management’. 

Relatives said medics failed to spot that he had developed mastoiditis — a serious bacterial infection of the mastoid bone behind the ear that is usually treated with antibiotics. 

Most sufferers recover quickly and have no complications as long as the condition is diagnosed and combatted quickly.

However, if the bone is severely infected and is not removed, it can cause life-threatening complications, such as a brain abscess and meningitis.

Parents Andrew and Anne suspect that the mastoiditis could have been spotted and treated with antibiotics if their son had a face-to-face examination at his first appointment last year. 

His parents said he was left alone in A&E despite being in a confused and in a serious state, and fell, suffering an injury to his head. 

Airline pilot Andrew said: ‘What we know now, is that a couple of days previously, he more than likely started to develop a brain abscess that was triggered by his ongoing infection in his ear.

‘Two and a half hours after that call, David took a selfie of himself to send to a friend.

‘I have no formal medical training other than first aid. But if I was to identify a picture of someone who was dying…’

And his mother said: ‘It’s been appalling care. I think they’ve completely let David down.

‘I am absolutely convinced as David’s mum, that if he’d been seen on that last consultation, he would still be with us today.’ 

Parents Andrew and Anne suspect that the mastoiditis could have been spotted and treated with antibiotics if their son had a face-to-face examination at his first appointment last year

An inquest into Mr Nash’s death is set for early 2023. It is expected to delve into what his family says are significant failures after he had been admitted to hospital.

An independent GP, who was shown documents on Mr Nash’s case, said there were ‘several points in time where David should have been reviewed face to face’.

Dr S L Brown — a GP since 1984 — said he could not determine whether Mr Nash would have lived if he was seen earlier.

However, he labelled the decision to prescribe pain relief when he was so unwell ‘a breach of duty’.

Professor Martin Marshall, chair of the Royal College of General Practitioners, said: ‘We know that bad things have happened.

‘We know that mistakes have been made. And that’s desperately sad when that has happened.’

He pointed to the GP crisis, with six in 10 doctors warning that their mental health has deteriorated in the last 12 months.

Rising numbers of the workforce are reducing their working days, which is piling more pressure on the service, Professor Marshall warned.

‘So we’re in a situation now where the service is not stable and is untenable. It can’t carry on like this,’ he added.

In a statement, the GP surgery where Mr Nash was treated said: ‘We would like to again extend our condolences to Mr Nash’s family, and our thoughts are with them at this difficult time.

‘It would not be appropriate to comment further as the inquest is ongoing.’

NHS England for Yorkshire and Humber said it had ‘investigated the family’s complaint regarding their son’s treatment within primary care and provided them with a response’.

The full report airs on BBC Two’s Newsnight at 10:30pm tonight.

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