Man dies of heart attack, unable to be brought back for surgery, coroner slams Dagenham GP practice

A coroner has strongly criticized the practice of a general practitioner over the death of a patient who complained of chest pains and received no response to repeated phone calls.

Keith Smith, 75, died of a heart attack last July after seeking medical care at Church Elm Lane Medical Practice for three days.

On two of those days, the practice team said they would call him, but they didn’t.

Coroner Graham Irvine has now slammed Mr Smith in a scathing report by Dagenham coroner for his “disorganized” and “unprofessional” response to the call.

The clinic said it had hired “more qualified staff” following his death, but health and social care regulator the Care Quality Commission (CQC) is investigating whether regulatory action is needed.

An autopsy conducted by Mr Irvine determined that Mr Smith died of a heart attack caused by arterial disease.

The grandfather of two, who lived with his wife on Western Avenue, began experiencing severe chest pain radiating to his neck in July 2023.

His family said they initially thought the pain was related to chronic sciatica.

The coroner said Mr Smith called the surgery’s reception desk on July 3, 4 and 5 to seek treatment from his GP.

“The post-surgery response was chaotic, and the behavior of those answering the phones was unprofessional and, in some cases, inappropriate,” Irvine said in an unusual “Prevention of Future Deaths” report issued to the clinic. I mentioned it in the. “On July 4 and 5, 2023, Mr. Smith was advised that he would receive a return call from his GP, which he did not receive on both days.”

Mr Smith’s daughter Karen Smith told the Standard that her father would have visited A&E or a walk-in hub if advised to do so, but instead followed instructions from his GP practice and waited to hear back.

she said: “I’m tired of the way they treat my father. We all are. Lack of communication…Big, big changes need to happen.

“Apparently they didn’t care. They didn’t care. They were complacent.”

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She added that she felt GP receptionists needed to recognize the lesser-known symptoms of a heart attack and provide directions to people who needed emergency treatment. On the night of July 5, Mr Smith’s family, frustrated that they could not be reached, called 111 and were transferred to 999.

An ambulance rushed to Mr Smith’s home and paramedics found him suffering from a heart attack.

“Shortly afterwards” Mr Smith went into cardiac arrest. Emergency personnel attempted to revive him, but he was pronounced dead just after midnight on July 6.

In a statement to Mr Smith’s inquest, his family said: ‘We will miss Keith, husband, father and grandfather every day.

“Keith has been the biggest force in our lives, his purity, inspiration and motivation has driven us with his love and great passion for everything.

“Keith’s memory will live forever in our hearts and souls for the rest of our lives.” The “Preventing Future Deaths” report said the coroner said “unless action is taken, future deaths will be… It is created when you believe that there is a possibility that something will happen.

Mr. Irvine writes: “The GP surgery said changes to its procedures, staffing and training following Mr Smith’s death led to improvements such as recording patient calls, escalating patient inquiries to GPs and monitoring GP calls. “We cannot provide convincing evidence that” – Return to the patient. ”

When contacted by the Standard, a spokesperson for Church Elm Lane Medical Practice said: “Mr Smith’s death is a tragedy and we extend our deepest sympathies to his family, friends and loved ones.” .

“Our practice has taken the coroner’s comments and reflected on this case in detail to ensure that the concerns raised are addressed and treated as a priority.

“Since this tragic incident, our clinic has hired more qualified staff and put in place clear guidelines for appropriate care and call handling that all staff are following.

“Additionally, to ensure that concerns raised by coroners are appropriately addressed, the coroner’s office is conducting an audit of calls to clinics to assess appropriate handling and escalation. ”

Church Elm Lane Medical Practice was rated ‘good’ in all areas when last inspected by the CQC in 2017.

Coincidentally, on 6 July 2023, the day of Mr Smith’s death, the CQC carried out a review into whether another test was needed. “We have not found any evidence that the ratings need to be reassessed at this stage,” it said at the time.

Following the coroner’s criticism, a CQC spokesperson said in a statement to the Standard:

“We are currently reviewing this report to determine whether any regulatory action is necessary.

“We also encourage anyone with concerns about health or social care services to raise their concerns with the CQC through our website, email enquiries@cqc.org.uk or call 03000 616161. We recommend that you do so. This information will help you decide when and where to test.”