Boy, 9, died from sepsis days after being sent home from hospital with flu

Concerns that a nine-year-old boy had appendicitis were "dismissed" by hospital staff before he died from sepsis caused by a perforated appendix, the boy's father has told an inquest.

Dylan Cope, from Newport, was initially taken to the Grange Hospital in Cwmbran on the evening of December 6, 2022, after being referred by his doctor over pain in his abdomen.

Later that night he tested positive for influenza and was discharged with a factsheet about coughs and colds for children over the age of one.

On December 10, he was rushed back to hospital after his condition rapidly deteriorated.

Dylan died from septic shock from a perforated appendix on December 14 after spending days in intensive care at the University Hospital of Wales in Cardiff.

An inquest into Dylan's death is being held at Newport Coroner's Court, and is due to last for a week, mainly focusing on the interactions between Dylan and medical professionals between December 6-10 that year.

On the opening day of the inquest, a statement was read on behalf of Dylan’s father, Laurence Cope.

He described Dylan as a fit and healthy boy who “enjoyed life and his family very much”.

Dylan was described as “a blend of feisty and sensitive” and would spend time baking, wrestling his brother and completing puzzles like Rubik’s Cube.

The inquest heard Dylan had been unwell on December 2 and vomited but by December 4 had returned to normal other than having a mild cough.

He was not sent to school as his parents were concerned about him passing on any illness or picking up something like Strep A.

By the evening of December 6, Dylan reported that the pain in his lower abdomen had worsened to excruciating pain.

Giving evidence to the inquest, Dylan’s GP Dr Amy Burton said his symptoms were consistent with acute appendicitis and referred him to the local hospital.

On the first day of the inquest, on Monday, 20 May, the coroner's court heard from Samantha Hayden, a paediatric nurse practitioner at the Grange Hospital who was the first person in the hospital to assess Dylan.

She told the inquest that she had not read the GP’s referral before she made an assessment of his condition.

Caroline Saunders, the senior coroner for Gwent, asked Miss Hayden: “Would that not have helped you understand more about his condition?”

The nurse practitioner told the court: “Yeah, it certainly would have helped."

Asked why she had not read the GP's notes that evening, Miss Hayden said the unit had been “exceptionally busy”, and that she did not want to spend time on a computer reading his notes.

She said: “I thought it was more important to see Dylan."

She told the inquest she did not remember whether Dylan or his father had explicitly mentioned severe abdominal pain, but accepted she “probably should have taken longer to get him to describe the severity of the pain”. She noted he had expressed several times that the pain was worse on the left side.

The nurse practitioner said she did not think that Dylan’s symptoms were consistent with appendicitis, but denied she “disregarded” it.

Just after 10pm on December 6, Dylan tested positive for influenza A, and it was determined by hospital staff that the pain he was experiencing was due to swollen glands.

Miss Hayden described Dylan as having a “mixed bag” of symptoms, suggesting one or other diagnoses, but no blood tests were requested.

She said he had swollen lymph nodes and congestion in his throat and that his symptoms were a "mixed bag", which indicated a number of possible causes including flu, appendicitis and peritonitis, noting that tests for influenza had come back positive.

The coroner asked Miss Hayden: "Irrespective of whether Dylan had appendicitis or flu, would a blood test have helped?”

She replied: "Possibly… maybe not me or my role but it could have further aided my senior colleagues."

Dylan was sent for observations just before midnight on December 6 by other medical staff. His observations showed an increase in temperature from 37.4 degrees celsius to nearly 39 degrees. Miss Hayden told the inquest that these observations were not shared with her.

Miss Hayden said a senior review was planned for another healthcare professional to carry out on Dylan. She later completed a discharge summary before this senior review took place.

Miss Saunders put it to her that this indicated she had "already made up her mind" about what was wrong with Dylan, but Miss Hayden said these summaries were "pre-empted" and later reiterated that the fact a senior review was happening would not be something she would have to include.

Questioned by Dylan’s family lawyer, the nurse practitioner told the inquest she had been told by senior colleagues following the incident in December 2022 that her documentation needed to improve, and she had done so but without any further formal training.

The inquest also heard evidence from Peter Bassett, a nurse with 20 years' experience on the children’s assessment unit at Aneurin Bevan University Health Board.

Mr Bassett told the inquest that in the early hours of December 7 he had been told by an unnamed doctor unknown to him that Dylan could go home.

The coroner asked him: “Did you check that he had had a senior review [by a doctor]?”

Mr Bassett said: “No, I’d been given his discharge form which usually is only done when they’d had a senior review so I assumed that had been done."

The coroner continued. “So before Dylan leaves, you did not check his observations or give him a final check?”

“No," the nurse replied.

Mr Bassett added that he should have been made aware that Dylan’s heart rate and temperature was up and he had not had a senior review from a doctor, but he told the court that he was not informed.

Dylan’s father, Laurence, was given a leaflet about cold and flu for children and told he was fine to take his son home.

Mr Cope was told that he could expect Dylan’s condition to improve in a few days, but instead it worsened.

On December 10, 2022, Dylan's family were concerned he was not improving and called the emergency number given to them when they left hospital. Just before midnight they got through at the 19th attempt and were told to call the NHS 111 number.

Dylan's father rang 111 and while he was waiting on hold they noticed Dylan was breathing more quickly. He was on the phone waiting for more than two hours before getting through at 2.45pm. He said his son had cold hands and feet and was told by the call handler that a doctor would call them back.

Dylan changed from comfortably watching TV to writhing around on the sofa with his legs beginning to mottle.

Mr Cope’s statement to the inquest described Dylan as going “limp and frail” and looking like he wanted to sleep.

After rushing him to hospital, Dylan was eventually operated on and moved to intensive care at the University Hospital of Wales in Cardiff.

There it was eventually decided that Dylan’s suffering was only being prolonged, and the decision was taken to gradually take him off life support.

Mr Cope’s statement said he and Dylan’s mother felt as though staff in the Cardiff hospital had “left no stone unturned” and praised their compassion throughout.

The inquest at Gwent Coroner's Court in Newport is due to last for five days.

Want a quick and expert briefing on the biggest news stories? Listen to our latest podcasts to find out What You Need To Know…