A 39-year-old woman found dying under a coat in an overcrowded emergency department in Nottingham may have been missed by staff who were used to homeless people sleeping in the waiting area, an inquest has heard.
Inga Rublite entered the emergency room at the Queen’s Medical Centre (QMC) at 10:40pm on January 19 with severe headache, blurred vision, high blood pressure and vomiting.
Rublite, a mother of two, was last assessed by medical staff at 2 a.m. on Jan. 20. However, when she failed to respond after her name was called at 4:30 a.m., 5:26 a.m., and 6:50 a.m., she was assumed to have gone home and was discharged from the system.
Rublite was found by staff at 7am, slumped on the floor with a jacket over her face, where she had vomited and had a seizure. She was taken to intensive care but had suffered a severe brain haemorrhage and died two days later, on 22nd January.
During an inquest into her death on Wednesday, before Nottinghamshire Assistant Coroner Dr Elizabeth Didcock, QMC Medical staff reported that the evening Rublite arrived, they were experiencing patient overcrowding and staff shortages.
When asked why more wasn’t done to find Rublite when she was unresponsive, Dr. Robert Jamieson, an emergency physician at the hospital, said: “I have no explanation for it other than that the constant barrage of needing to do the next thing, see the next person, means that these things, which seem so obvious, just don’t happen.”
According to staff, they also tried to call Rublite’s cell phone, but her twin sister, Inese Briede, said there was no evidence of a missed call at the time.
Luke Derby, an adult lead nurse in QMC’s emergency department, said there were 61 patients in the waiting room that night and anything over 38 was considered over capacity. Including family members, there would have been 80 to 90 people in the waiting room where Rublite was.
Jamieson said: “We’re never not busy, this is an average of what we would expect in our department. It’s always like that.”
Rublite was sitting in a chair in a 10-foot-wide hallway off the main waiting room, next to double doors leading to another department. Employees likely walked past her several times during the night, Derby said.
He said seeing someone sleeping under a coat was a common occurrence at the hospital, as homeless people used the waiting room as a place to sleep during the winter months. Derby said: “Someone sleeping under a coat in our waiting room is not unheard of, we have a lot of homeless people coming into our unit and it is busy and noisy.”
Rublite’s chair was out of sight of the head nurse’s station. The row of chairs she was sitting on has been moved to prevent something like this from happening again.
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The investigation also found that there was no experienced physician present in the triage department where Rublite was initially assessed due to staff shortages, and no CT scan was requested despite her symptoms indicating she needed one.
Jamieson said the scan would likely have shown evidence of bleeding on her brain and that she could have been treated for a brain haemorrhage by 1 or 2am if it had occurred after she arrived.
When she was last assessed at around 2am, her pain had increased from mild to severe and her heart rate had also increased, the inquest heard. It was two hours later when she was called back for further observation.
The investigation is still ongoing.