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Abstract

Serious safety concerns about the Whittington’s accident and emergency department have sparked a major recruitment drive by hospital chiefs.

The Care Quality Commission inspection report said “there was not sufficient consultant cover” in A&E and that the Archway NHS Trust was in breach of Royal College of Emergency Medicine standards.

It added that there were too many locum (temporary) doctors and junior doctors were concerned about consultant cover overnight, which “poses a risk” to patients.

The Tribune can reveal that the hospital is recruiting six A&E consultants in addition to the existing team of 12.

The recruitment drive comes in the week a coroner’s inquest probed the death of a patient who suffered a catastrophic internal bleed while waiting to see a doctor for four hours at the Magdala Avenue casualty unit.

Paul Gage, 59, arrived at 7pm and was marked as needing assessment within 10 minutes. At 11pm, he was diagnosed with a suspected aneurysm – a swelling of an artery – in his stomach.

The aneurysm ruptured at around midnight as he waited for a scan to confirm his condition. He was taken to the Royal Free Hospital, in Hampstead, for surgery, but died on the operating table, the St Pancras inquest heard on Friday.

The Whittington emergency department had been severely overcrowded and did not have enough resources to deal with patients arriving on March 17 this year, the inquest heard.

Stephen Moore, head nurse at the Whittington, said: “The department was under a great deal of pressure. [It] had more patients than it had capacity for at the time.”

The hospital launched a review of events leading up to the death. Medical consultant Ben Killingley said that, had Mr Gage been assessed quicker, it was “possible, but by no means certain, the outcome could have been different”. He said: “I think the rupture already happened before, but the body was able to contain that with clots.”

Barrister Samantha Presland, representing Mr Gage’s family, questioned the assessment that the rupture had taken place before he arrived at the hospital.

Coroner Richard Brittain agreed to adjourn the hearing until the surgeon who operated on Mr Gage could attend and give evidence.

Leena Savjani, a specialist medical negligence lawyer, said the family “has been absolutely devastated by Paul’s death.”

Before the hearing was adjourned, Dr Killingley told the inquest that the hospital had introduced a number of changes in the wake of Mr Gage’s death.

He said: “Emergency department staffing nationally is difficult. In this case it’s evidenced by having four locum doctors there overnight.” He had no concerns over the competency of these doctors.

The court had heard that a doctor was called to see Mr Gage at 10pm, but difficulty in finding the patient notes caused additional delays. Dr Killingley said: “I’m not sure it had any direct effect on the outcome of the case... but strengthening and recording better nursing notes is something we want to try and do.”

A hospital spokesman said: “We have been in regular contact with Mr Gage’s family and have been working closely with staff to put a clear action plan in place.