Pauline Austin, 71, of Tooting, was waiting for hours for an ambulance that she and her caregivers did not know that she had canceled.
In all, he lost conscious and personal in his home in the East London Care, to which he had moved only a few months earlier, he marked 999 for the second time.
But when he arrived at the Whipps Cross hospital, about eight hours after the initial call of 999, he had suffered a bleeding in the brain so “catastrophic” that an expert in stroke said that “it was not compatible with survival.”
Born in British Guyana, Mrs. Austin worked for 21 years as an administrator of the Bank of England and also had a job in civil service and Bank of America.
She was “fun, generous and always worried about how others saw her,” said his daughter Rebecca in an investigation in the East London Forener’s Court, Walthamstow.
But after being redundant of Bank of America, his mental health deteriorated. He became “lonely” and “would create conspiracies in his head, listen to music and voices that were not present.”
Hip operations in the Blackheath and Lewisham hospitals left her with mobility problems, she was told to the court, and in 2021 she was diagnosed with her dementia.
In December 2023, Mrs. Austin moved Harts House Care Home in Harts Grove, Woodford Green, to be close to Rebecca.
In March 2024, Rebecca and his partner went on vacation and returned to find Mrs. Austin in worse conditions that when they left, he said in a statement.
The “speech of Mrs. Austin worsened.” “He could not follow prayers,” a tremor developed that he had not been able to grab objects or feed.
On April 18, he was vomiting, which continued until April 19.
The staff marked 999 to request an ambulance at 4.52 pm, but none was noticeable.
The London ambulance service (LAS) said the waiting for an ambulance was about two hours.
But, in what the coroner, Dr. Shirley Radcliffe, called “an almost incredible coincidence,” the care home also recently called an ambulance for other Resident of Elders in a different story of the building.
A member of the personnel of the notice two calls to the same direction and mistakenly assumed that he was a “duplicate”, so he canceled one, which turned out to have been Mrs. Austin.
But testifying in the name of the London ambulance service, the Head of Quality Guarantee Control Services Sue Watkins told the court that the decision to send an ambulance in the first place had been a mistake.
She said that the symptoms of Mrs. Austin at that time (nausea and high blood pressure) would probably have resulted in a derivation to NHS 111 to obtain advice, and only an ambulance was requested because the manager of people he calls by the person who erroneously calls a medal.
About five hours later, Mrs. Austin was found unconscious with “fixed and dilated” pupils.
When he arrived at the hospital, said the expert in stroke Dr. Robert Simister, “there was no reversible treatment.”
But its symptoms as the day was developed had bone “consistent with an intracranial hemorrhage of development,” he said.
If Mrs. Austin had been treated earlier, said Dr. Radcliffe, her death “could have been avoid.”
“But we cannot say, about the balance of probabilities, I would do it Avoid the leg, “he added.” It was a very significant bleeding that was found when it was admitted to the Cross Hospital -Whipps Hospital. ”
Anyway, said the coroner, the error that saw the original ambulance canceled should not have happened and “there is a risk that this may happen in a case in which it could make a big significant difference.”
Mrs. Watkins said the ambulance service had distributed guidance to all personnel to verify the details of the possible duplicate calls before eliminating one of the issues.
He added that the service hoped to update your computer system soon to remember the staff to verify the details before allowing them to eliminate the calls.
“Humans are human,” he said. “There are errors that will happen.”
Attributing the death of Mrs. Austin to “natural causes”, Dr. Radcliffe gave his condolences to the family.
“She was clearly very loved, and moved to a careful home so you could visit every day,” he said.
