The family of a mature law student believe his life could have been saved if he had been seen face-to-face by a GP.
David Nash, 26, had four remote consultations over a 19-day period before he died from an infection that could have been treated on 4 November last year.
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None of the clinicians managed to spot that he had developed mastoiditis in his ear which caused a brain abscess and led to meningitis, his family have said.
The 26-year-old first contacted Burley Medical Centre in Leeds on 14 October 2020 after spotting an enlarged lump on his neck, and was given a phone consultation with a GP.
Mr Nash’s father believes that a physical examination at this point would have identified that his son was suffering from mastoiditis, but the GP decided to see how the lump developed and arranged for a blood test to be conducted 19 days later, if the problem persisted.
Notes later released to the family showed that this would be reviewed sooner if additional symptoms appeared, including a fever.
Mr Nash said his son contacted the practice again on 23 October complaining of ear pain and again was dealt with on the phone, this time by a nurse practitioner.
He said no medical history was taken, which would have revealed his history of chronic middle ear disease, and mastoiditis was ruled out despite no physical examination taking place.
Five days later, David phoned the GP service again after suffering from a fever for four days and passing blood in his urine.
He was prescribed antibiotics over the phone for a possible urinary tract infection (UTI), despite the doctor admitting there were no other signs of this and tests later confirmed no evidence of such an infection.
After becoming increasingly unwell with a nine-day fever, debilitating neck pain, pain behind his eyes and in his sinuses, nausea and nocturnal headaches, Mr Nash phoned the GP service for a fourth time on 2 November, the same day he was supposed to have a blood test.
However, the nurse instructed him not to come in for the test due to his fever, as it is one of the main symptoms of Covid-19. This instruction came despite Mr Nash testing negative for coronavirus.
His father said: “Ironically, the very symptom that was indicated to prompt an earlier review, is now used as the reason for cancelling his appointment.”
Mr Nash was told he sounded like he was “feeling a bit sorry for [himself]” and was told to take codeine, which appeared to make him drift in and out of consciousness.
His health deteriorated even further over the course of the day, prompting his partner to make the first of five “shambolic” calls to the NHS 11 number, during which his illness was once categorised as “dental”.
According to transcripts obtained by the family, the call handler had a private “sidebar” conversation with a clinician who said “I can’t do with these that won’t talk to us” and advised he was not to be prioritised further just because he was vomiting.
It was not until the fifth call that the call handler indicated an emergency response due to a possible stroke, which led to Mr Nash being taken by ambulance to St James’s Hospital in Leeds.
It took more than four hours to arrange a CT scan, despite Mr Nash being admitted with confusion and bradycardia, which are signs of raised intracranial pressure.
He was also left alone in the Emergency Department, even though he was in a confused and serious state, and fell after trying to stand, causing him to suffer a head trauma.
Mr Nash sadly died two days later despite valiant efforts from neurosurgeons to save him.
What has his family said?
Mr Nash’s father, 56, said that his son should never have been allowed to get to the stage where he needed emergency treatment as doctors should have recognised the treatment sooner.
The parents of the 26-year-old, who was just starting his second year of a law degree at the University of Leeds, said they believe their son would still be here if he was granted an in-person GP appointment.
Mr Nash told the PA news agency: “He should never have gone to A&E in that condition. It is something that should have been sorted out way before then and, having approached his GP practice on four occasions, not to see him I think is the primary reason that they failed to recognise his condition and treat it.”
“Here was a man who had presented four times in short succession with a range of escalating symptoms, and had a fever for nine days despite a negative Covid test, and there still was no clear diagnosis.
“I wish David had had Covid. If he had had Covid, he would have been treated. That’s the irony.”
Mr and Mrs Nash are now paying thousands of pounds for an independent neurosurgeon to investigate how their son died and are hoping an inquest, due to start in Wakefield on 30 November, will provide clearer answers.
The family also hope that the tragedy will help to shift attitudes from GPs towards face-to-face appointments.
Mr Nash added: “How do you diagnose an ear infection, what type of ear infection it is without actually looking in the ear?”
“I would argue that any of the symptoms he exhibited, that would have required an examination of the ear, would have revealed the true extent of his chronic middle ear disease and his mastoiditis which, in effect, was ground zero for the complication he developed.”
“They should be opening up – triaging, but seeing patients appropriately. I think the public fear is that they’re never going to return now to seeing people.”
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