A bride-to-be died from swine flu less than six weeks after a doctor working for a GP out-of-hours service in Oldham diagnosed her with a routine chest infection, an inquest heard.
Mother of one Joanne Oliver, 31, had rung the 6pm-8am service for medical advice after complaining about a severe cough, aches and pains and bouts of sickness.
But although her condition was initially treated as urgent, it was downgraded to routine by a doctor during a subsequent 16 minute face-to-face consultation at the Barley Clough medical centre in Oldham, Greater Manchester.
Miss Oliver, a Next clothing shop assistant who was asthmatic, was prescribed amoxicillin and other medication to control her temperature and she was sent to a pharmacy.
Just six days after the consultation, her condition deteriorated ‘drastically’ and she was admitted to Royal Oldham Hospital A&E with breathing difficulties where she was rushed into intensive care.
After being initially thought to have pneumonia she was found to have the H1N1 strain of swine flu and was transferred 140 miles away for specialist treatment at Newcastle’s Freeman hospital.
She spent more than three weeks fighting for life before being airlifted back home, but died shortly after her arrival at Manchester Royal Infirmary.
It emerged the doctor who treated Miss Oliver did not think she had swine flu as at the time GPs had not been given any directions about screening patients for a possible strain of the illness.
Five months before Miss Oliver’s death on January 17, 2011 the World Health Organization declared the notorious 2009 swine flu pandemic officially over.
A week after her death GPs were ordered to start screening patients again for the disease.
The Manchester hearing was told the tragedy occurred after Miss Oliver, from Fitton Hill, Oldham complaining of feeling unwell.
She rang the Go To Doc service and was questioned by a trained call handler before speaking to a nurse.
She then had a 16 minute consultation as part of the three stage service with Dr Susan Nelson at the medical centre on December 7, 2010.
Dr Nelson said: “Her symptoms included aching all over, back pain and vomiting. She had a slight ear ache, sharp pains and pains in muscles and she said the coughing hurt.
”I listened for any sounds on the chest and I listened to the heart as some conditions target it. There was air entry on both sets of lungs.”
Dr Nelson said Miss Oliver did not have a wheeze but showed signs of a chest infection.
He said there were no signs of shallow breathing and there was no indication she had major breathing difficulty.
He said: “I diagnosed her with Lower Respiratory Tract Infection.
”I believed she had a chest infection. This was the same diagnosis given by the doctor she spoke to over the phone.”
Dr Nelson prescribed amoxicillin and an analgesic to help her temperature and advised to see her GP in 48 hours if her condition failed to improve.
The hearing was told patients of Go to Doc are differentiated into ‘urgent’ and ‘routine’ cases.
Because Joanne had phoned in and was assessed by call handlers and seen by a triage nurse and then a doctor her case was labelled as urgent but Dr Nelson herself downgraded it to ‘routine’ having examined her.
Asthma patients are among an ‘at risk’ group who can be prescribed anti-flu medicine Tamiflu by GPs outside a flu epidemic period.
But when asked by assistant coroner Robert Chapman if Joanne should have been treated as an ‘at risk’ patient, Dr Nelson said: “In terms of a chest infection, no. There was a question of an asthma diagnosis but I did not feel she was an acute asthmatic.”
Mr Chapman asked Dr Nelson: “One of the main issues is the emphasis made to Joanne about how important her state of health was at the time. Did you think she had got swine flu?”
Dr Nelson replied: “No. It was before we were directed as GPs to look for swine flu which was a week later.”
Earlier Miss Oliver’s stepmother Patricia Oliver, 75, told the Manchester hearing: ”Joanne used to walk everywhere, she was quite fit but she was a bit down at the time.
”We were just told she had an infection but we first realised she was very poorly when we got a phone call from her saying she was going to A&E.”
Joanne was admitted on December 13 and began gradually deteriorating.
Mrs Oliver said: ”When we went there she was in a mask. We were told initially that she had got pneumonia but later we were told it was swine flu.”
She was in the intensive care unit at Oldham hospital before being transferred to Freeman’s Hospital in Newcastle.
She added: ”At Freeman’s her mum spent time with her. We rang three times a day to make sure she was okay.
“We spoke to the nursing staff on the ward but just her mum went to see her. We were told she had got to the stage where could transfer her back to Manchester.
”It was a shock to know she was coming home so soon. There was no discussion about the reason why she was being transferred. We assumed it was because it was quite expensive treatment.”
Mrs Oliver said she went to see her stepdaughter when she arrived back in Manchester around 5pm and was told she had arrived at 3pm into the ICU.
Mrs Oliver was allowed to see her at 7.30pm. She was comatose at this point.
She added: ”At first a doctor had come to see us while we were waiting to see her and I felt elated. He said she would be okay, she would be fine.
“The information we were given then was very positive. We were with her for about 10-15 minutes and then we left to go home.
”We got a call when we arrived home that said to come to the hospital. She had died.
”We have had all these reports. They said she was in a critical condition when she left. Why was she transferred when she was in such a critical condition? Why was she not brought back by ambulance, why not come back by road.”
Dr Peter Holden, GP and expert witness said at the time of Miss Oliver’s illness no advice was being given by NHS about the issuing of Tamiflu and concluded Dr Nelson ‘had done nothing wrong’.
He added: “Dr Nelson would not have been able to give Tamiflu even if she wanted. Out of hours is a high risk operation.”
Coroner Mr Chapman said: “I am not concerned over the examination of Joanne.”
The inquest continues.
Image courtesy of KGGucwa, with thanks.
