Tanya McCartney, a 25-year-old mother from the Midlands, died at home on May 19, 2023, after staff at Chesterfield Royal Infirmary in Derbyshire failed to diagnose her pneumonia, a coroner has ruled. Assistant Coroner for Derby and Derbyshire Anita Davies said at an inquest this month that Tanya's death should have been prevented.
Tanya had gone to A&E on May 18 with a high temperature, shortness of breath and a painful throat, believing she had caught a cold from her young son Marcus. She attended on the advice of her GP. However, NHS staff did not spot that she had pneumonia, a condition that could have been treated with a course of intravenous antibiotics. Instead, a trainee mental health nurse sent her home with oral antibiotics, and she died the next day.
Coroner's verdict: 'Should have been admitted'
In her narrative verdict, Ms Davies stated: "Had Tanya been admitted on the May 18 and given appropriate intravenous antibiotics it is more likely than not that she would have survived. The decision not to admit Tanya to hospital on the evening of the May 18, but rather to offer her a choice between admission or return home, contributed to the death."
Chesterfield Coroners' Court heard that Tanya had a very high heart rate and soaring temperature when she was given the option of being discharged. Ms Davies told the inquest: "Three hours before discharge her vital signs had been significantly outside of normal range and merited further monitoring and investigation. Given the clinical picture, the trust accepts that Tanya should have been admitted for further observations and intravenous antibiotics. The trust accepts that had she been admitted and given intravenous antibiotics, on the balance of probabilities she would have survived."
Family's account and aftermath
After returning home, Tanya complained to her mum Natasha about her treatment, calling it 'a waste of time'. Her health deteriorated, and she collapsed on her sofa the next day. Despite paramedics' attempts to resuscitate her, she died.
Her mother Natasha, who now cares for four-year-old Marcus, said: "She is missed more than I can ever describe. Every day Marcus asks questions about his mummy. One day he will want to understand what happened to her. We owed it to him, and to Tanya, to keep fighting until the truth came out. We welcome the verdict today, which finally puts into official words what our family has known since the terrible day Tanya was taken from us."
Natasha added: "Getting to this point has been an exhausting, painful battle. From the beginning, our family struggled to understand how Tanya could go to hospital desperately unwell and then die the very next day. We have waited a long time to find out the truth about what happened and why she died. While the hospital has accepted that, had Tanya been admitted for antibiotic treatment she would probably have survived, hearing that is devastating."
Trust apologises and introduces changes
Chesterfield Royal Hospital NHS Foundation Trust has since apologised to Tanya's family, admitting that 'Tanya would have, in all probability, made a recovery' had she received antibiotics intravenously. Kevin Sargen, medical director for the trust, said: "We send our sincere condolences to Ms McCartney's family and loved ones. We acknowledge that the care she received was not the standard that we strive for."
The family hired negligence lawyers Slater and Gordon to investigate Tanya's care. Their solicitor Rebecca Dowse said: "The inquest's narrative verdict, which acknowledged the trust's admission that discharging Tanya was inappropriate, is a stark reminder of the tragic consequences of incorrect clinical decision-making. We now know it was not just inappropriate to discharge Tanya; it was a fatal error that the trust has been forced to account for."
Since Tanya's death, the trust has introduced several changes, including better oversight of higher-risk patients and an electronic patient record system. Natasha concluded: "We can only hope that the trust takes the coroner's words to heart so that no other mother has to know their child's death was entirely preventable. We hope Tanya's death and the lessons identified have led to meaningful change to help ensure that no other family experiences the pain and heartbreak that we have endured."
