Doctor 'astounded' by how fast student fell ill

A doctor at the hospital where a 21-year-old died from a combination of sepsis, pneumonia and Crohn's disease has told an inquest he does not believe any treatment would have saved her.

Bethan James, daughter of former Glamorgan and England cricketer Steve James, died on 8 February 2020 at University Hospital Wales (UHW) in Cardiff after she had been seen at hospital on a number of occasions in the days leading up to her death.

Dr Duncan Thomas told Pontypridd Coroner's Court he was "astounded" at the speed of the deterioration in Ms James' health and that there was "no cure".

But an expert witness told the court he disagreed with Dr Thomas' assessment and said Ms James could have been saved.

Dr Thomas, who was in charge of resuscitation at UHW, said he had never seen anything like Ms James' deterioration in a patient of her age and only one other time previously in his career.

He told the inquest he did not believe anything would have saved the student from the moment she arrived at hospital two and a half hours earlier.

Doctors also concluded nothing more could be done to resuscitate her after she later went into cardiac arrest, the inquest heard.

Dr Thomas said Ms James, from Cardiff, had a viral rather than the more common bacterial form of sepsis.

She was treated with fluids and antibiotics but the consultant said "nothing we were providing would stop the ongoing pathological progress of that viral infection".

There were no drugs in use at the time to tackle viral sepsis, the inquest heard.

After arriving at hospital Ms James was seen by a triage nurse and sent to the acute "majors" zone of the emergency department for more than an hour rather than the highest level resuscitation area, the inquest heard.

Dr Thomas said it would have been appropriate for the hospital to be warned Ms James was being brought in by paramedics to the emergency department.

If he had received the alert, the consultant said he would have taken steps to attempt to create room in resuscitation where tests would have revealed an hour earlier how ill she was.

However, it would not have made any difference to Ms James' outcome, Dr Thomas told the coroner.

"It is my belief Bethan would have died," he said.

Dr Thomas said that given the results of the tests it was likely she had had sepsis for "some considerable time, likely hours".

Under questioning from Ms James' family's lawyer, Dr Thomas agreed with earlier high level intervention the time she went into cardiac arrest may have been delayed - but maintained she would likely still have done so.

Dr Thomas said: "Bethan's death had a profound impact on myself. She died in an atypical and rapid way which has stayed with me."

However, expert witness Dr Chris Danbury, a consultant in intensive care at University Hospital of Southampton, said she should have been taken directly to resus.

He said: "If you intervene aggressively as they come through the door you can avoid cardiac arrest."

When asked by the coroner Patricia Morgan if she would have likely survived, he said "yes, completely", adding he had seen it many times in patients with viral pneumonia.

He added the hospital should have been warned about Ms James' arrival due to "red flag" observations taken by the first responder at her home, and then reviewed by a critical care specialist as soon as possible.

He added the sepsis would likely have not been present the day before, although it would be "speculation" to say when it began.

Pathologist Dr Anurag Joshi gave a case of death as sepsis caused by pneumonia, likely virus, with Chron's disease a contributing factor.

Dr Joshi said it was not possible to give accurate timings in of how long infection had been present, but he described it as "more likely days rather than hours".

The inquest was told that even though no cases of Covid-19 had yet been found in Wales, Dr Joshi said "in the setting of the developing pandemic, it was important to exclude coronavirus".

The inquest was adjourned until 17 June when the coroner will give her conclusion.