Doctor ‘astounded’ by speed of death of cricket star’s daughter, coroner hears

The doctor caring for the daughter of an England cricket star has said he was “astounded” at how quickly she deteriorated ahead of her death, a coroner’s court has heard.

Bethan James, 21, the daughter of former Glamorgan and England cricketer Steve James, died on February 8 2020 just a few hours after being admitted to the University Hospital of Wales (UHW).

A post-mortem examination found Ms James died of sepsis and pneumonia, with complications caused by Crohn’s disease.

Ms James, a journalism student at the University of South Wales, was treated by Dr Duncan Thomas, who said he was surprised by how quickly her condition worsened when she was brought into UHW.

‘Frustration’

Dr Thomas expressed “frustration” that Ms James had not been brought to the resuscitation area – used for treating the most seriously-ill patients – earlier.

While he did not believe there was anything that could have been done to save her, an expert witness disagreed, saying earlier intervention could have made a “huge difference”.

Addressing South Wales Central Coroner’s Court on Thursday, Dr Thomas said: “I was, I think it’s fair to say, astounded at how quickly Bethan was deteriorating.

“The rate of Bethan’s deterioration was not something I had previously observed in someone of her age group, and, in my career, I have only ever seen it one more time.”

While dealing with another emergency patient in cardiac arrest, Dr Thomas was informed of Ms James’s worsening condition.

He said: “When I went back, Bethan was in a highly distressed state, likely as a result of multiple factors.

“She was on the edge of the bed, holding on to her mother – Bethan looked extraordinarily unwell.

“It was my clinical impression at that time that we would be looking at Bethan’s cardiac arrest within a short period of time.”

Paramedics

Throughout the inquest, concerns were raised over whether more could have been done earlier, including over paramedics failing to alert the hospital about the seriousness of Ms James’s condition before she was brought in.

While Dr Thomas said the hospital should have received a “pre-alert”, he did not believe it would have saved her life, with damage to multiple organs already present before she arrived.

“It’s my belief that, unfortunately, Bethan would have died,” he said.

“Bethan’s presentation and rate of deterioration were incredibly atypical of someone of her age group.”

He told the coroner, Patricia Morgan, that Ms James was suffering from a viral, rather than bacterial, form of sepsis, which meant that any antibiotics they were using would not have helped.

“There would have been nothing that we were providing that would have stopped the ongoing pathology of the viral infection,” he said.

Dr Thomas said Ms James’s death had a “profound” impact on him and other staff at the hospital, adding: “I wish there was something I could have done”.

Dr Anurag Joshi, the pathologist who carried out Ms James’s post-mortem examination, said Crohn’s, an inflammatory bowel disease which he listed as a contributory factor in her death, can lead to immune suppression.

Ms James had suffered with gastrointestinal issues for most of her life and had been diagnosed with Crohn’s disease in 2019.

Following complaints of being short of breath, Ms James was diagnosed with community-acquired pneumonia in late January and given antibiotics.

Her condition continued to decline and she was taken to Llandough hospital twice before she was admitted to UHW on February 8.

Delay

Dr Chris Danbury, an expert witness from University Hospital Southampton, said he disagreed that nothing could have been done to help Ms James.

Dr Thomas had said not moving Ms James to the resuscitation area earlier had led to around an hour’s delay in testing her lactate levels, but he did not think the treatment would have been different.

High levels of lactate in the blood indicate a problem with the body’s oxygen supply and are often elevated in those with sepsis.

Dr Danbury said knowing that Ms James’s levels were high could have helped provide treatments, such as fluids, sooner, with the hour’s delay making a “huge difference”.

“I see patients like this frequently and if you intervene aggressively as they come through the door, you can avoid cardiac arrest,” he said.

He disagreed that the case was atypical, arguing it fit with a patient who had been “partially treated” for pneumonia.

He also disagreed with the assessment that it was most likely to have been a viral form of sepsis, instead believing that there was a bacterial element that did not show up in the post-mortem examination.

The coroner adjourned the inquest until June 17.