Student from Nantwich who died after remote consultations ‘should have had urgent appointment’

A law student who died after a series of remote consultations with doctors and nurses should have had an urgent face-to-face appointment after his fourth and final contact, a GP expert has told a coroner.

David Nash, 26, had four phone consultations with a Leeds GP practice over a 19-day period in October and November 2020, an inquest in Wakefield, West Yorkshire, heard on 16 January.

The court heard that Mr Nash's condition dramatically worsened after the final consultation on 22 November.

He died two days later after he was taken to hospital following a series of NHS 111 calls.

It was later found that he had developed mastoiditis in his ear which caused an abscess on his brain, leading to his death.

Assistant coroner Abigail Combes read a statement from GP expert Alastair Bint, who said a nurse should have organised an urgent in-patient appointment after a phone consultation on 2 November 2020.

However, Dr Bint said he did not criticise the remote nature of Mr Nash’s first three consultations on 14, 23 and 28 October 2020.

The expert concluded that Mr Nash’s consultation with advanced nurse practitioner Lynne White on 2 November should have a generated a face-to-face appointment which is likely have led to a hospital admission.

Dr Bint said Mr Nash’s presentation of fever, neck stiffness and night-time headaches were “red flags” and the nurse’s diagnosis of a flu-like virus was “not safe”.

He said: “This was a patient that needed to be seen in person."

Dr Bint said it required “an urgent face-to-face assessment that morning”.

“Had he been seen in-person, it seems likely to me he would’ve been admitted to hospital.”

In his report, the doctor said he was asked to comment on whether the final outcome would have been different if Mr Nash had been seen face-to-face.

Dr Bint’s report stressed that the NHS was dealing with an unprecedented situation at the time, during the Covid pandemic, and that NHS England advice was for GP patients to be seen remotely in most cases.

The inquest heard that Mr Nash’s first phone consultation with the Burley Park Medical Practice was on 14 October, when he told GP Jenny Carrick he had been troubled by lumps on his neck.

Dr Carrick arranged for him to have a blood test booked in for 2 November.

His second consultation was with advanced nurse practitioner Amy Linstrum, when he described a painful and hot right ear. Ms Linstrum prescribed antibiotic ear drops.

The third consultation was on 28 October, with locum GP Manjoor Shahid. Mr Nash told the doctor he had blood in his urine and he was diagnosed with a urinary tract infection.

Nurse Lynne White told Mr Nash on 2 November, "you're sounding like you're feeling a bit sorry for yourself, are you feeling a bit rotten" and accepted that it appeared she was being dismissive in evidence given to the court.

However, she insisted she was simply reflecting that the patient seemed unwell.

Mr Nash’s parents, Andrew and Anne Nash, from Nantwich, Cheshire, have campaigned to find out whether the mastoiditis would have been identified and easily treated with antibiotics if their son had undergone a face-to-face examination earlier.

They have described how Mr Nash had five “shambolic” calls on November 2 with the NHS 111 system before being taken to St James’s Hospital in Leeds by ambulance, in a confused state, where he fell when he was left alone, causing an injury to his head.

Mr Nash died on 4 November 2020, despite efforts to save him by neurosurgeons at Leeds General Infirmary.

His mother read a pen-portrait of her son to the court on Monday.

She said she was “eternally grateful for an amazing 26 years of love and hilarity”.

Mrs Nash said: “Your huge smile, your compassion and your ability to enjoy every moment could never be replicated.”

The inquest continues.