Court: Romford mum died from Covid-19 after Queen's Hospital failings, inquest hears

Khudeza Choudhury, of Southern Way, was eligible for a drug which reduces deaths in Covid-19 patients by up to 21 per cent – but she never received it.

An investigation by the Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) found a series of failings.

Justin Daniels, BHRUT’s deputy medical director for professional standards, apologised that she "didn't receive the high level of care she was entitled to", and said BHRUT is "determined to learn" from what happened.

The 72-year-old spent 30 hours in A&E due to a lack of beds on Covid wards – described by BHRUT as “a significant service delivery problem”.

She was then inappropriately transferred to a ward, BHRUT said, when her condition deteriorated. She died upon arrival.

But the hospital said its own investigation did not find evidence of concerns raised by its staff in reports she may have been killed by a loose connection on a portable oxygen machine.

"She was such an elegant, gentle lady," said her daughter Sarah. "It's so sad. Everybody thought 'she will be okay, she's in the best country in the world, she will get her meds'."

Drug Delay

Mrs Choudhury was admitted with severe Covid-19 on the morning of October 24, despite being triple-jabbed.

By that night, she required oxygen therapy.

All Covid patients ill enough to require oxygen were eligible to receive Tocilizumab – an immunosuppressant known to reduce Covid mortality.

However, a doctor did not approve the drug for Mrs Choudhury until around midday the next day.

By then, her oxygen saturation was falling to levels “not compatible with life”, said Karen Hunter, who led BHRUT's investigation.

Coroner Dr Shirley Radcliffe placed on the public record that Mrs Choudhury had never received her Tocilizumab.

However, she said she could not find it proven that she would have lived if she had received the drug.

Respiratory medicine consultant Dr Robin Johns testified that Mrs Choudhury’s condition by the time he approved Tocilizumab meant "there was a very high mortality risk or expectation.”

Khudeza Choudhury died from Covid-19 around 19 hours after she became eligible for potentially life-saving treatment, but never received it (Image: The Choudhury family)

'Irony'

But, daughter Sarah Choudhury said that was 15 hours after her mother became eligible to receive it.

She said the family has been robbed of knowing if Mrs Choudhury could have survived if quickly treated.

“Twenty per cent is a huge chance,” said Sarah, who works for Covid vaccine inventor AstraZeneca.

“Some cancer drugs are given to people based on a five per cent chance.

“Mum had been waiting two years for Tocilizumab for her arthritis. She couldn’t get it because there was a shortage, because supplies were being diverted for Covid patients.

“The irony is that she then caught Covid and still didn’t get the drug.”

Sarah Choudhury with a treasured photograph of herself and her mother Khudeza, taken on her graduation day (Image: Archant)

Oxygen

BHRUT’s investigation followed claims by its own staff that Mrs Choudhury may have been starved of oxygen.

At around 4pm on October 25, she was moved from A&E to a ward.

A bed had been ready for almost five hours but staff waited to transfer her in the hope she would stabilise first.

When she did not, she was transferred with a portable oxygen machine.

On route, her oxygen levels fell further and her breathing became weak.

Staff should have rushed her to the nearest clinical area, BHRUT found, but instead continued to the ward, which took up to 15 minutes.

There, nurse Tabitha Kihayile disconnected the portable machine so she could hook Mrs Choudhury to an oxygen supply in the wall.

“I noticed that the tubing that goes to the O2 cylinder was loose,” she wrote in her notes.

Mrs Choudhury died within minutes of arrival.

Sarah Choudhury with her mother Khudeza (Image: The Choudhury family)

Dr Peter Tanner referred the death to the coroner, writing she “desaturated in transit between A&E and ward when O2 supply disconnected for 10-15 minutes".

“This contributed and was likely to be the cause of the sudden deterioration and contributed to the death."

But BHRUT later said the machine had been tested and no evidence was found that Mrs Choudhury’s oxygen supply was disconnected.

Dr Radcliffe concluded that Mrs Choudhury died of natural causes.

BHRUT

Justin Daniels, BHRUT’s deputy medical director for professional standards, said: “We are sorry Mrs Choudhury didn’t receive the high level of care she was entitled to when she was admitted to our hospital at the height of the Covid pandemic.

“We are determined to learn and have implemented changes to improve the way critically ill patients are moved.

“A thorough investigation established that Mrs Choudhury received oxygen correctly when she was transferred.”