Blackpool mum died of sepsis days after 'understaffed, badly organised' GP surgery found 'no signs of infection'

Sarah Dunn, 31, of Boothley Road, died of sepsis at Blackpool Victoria Hospital on April 11 2020, almost four weeks after undergoing a termination.

At her inquest today, it emerged the mum of five had reached out for help several times before being rushed to A&E with severe abdominal pains, nausea and sweating the day before she died.

Her mother, Marie Dunn, said: "Sarah was a beautiful, happy, loving, caring young lady. She was my second child and was a happy, fun-loving girl. I do not think I can ever come to terms with how cruelly she was taken from us."

The court heard that Miss Dunn had attended an appointment with her GP, Dr Sanjeev Maharaj, at the Elizabeth Street Surgery on April 1 after experiencing worsening vaginal bleeding, which a nurse had warned her about.

But Dr Maharaj said she appeared 'fairly well' and 'was not showing any signs of infection'. Her temperature was average and a standard blood test came back normal, though her heart rate was slightly elevated.

Dr Maharaj said: "She was not complaining of any pains or symptoms of infection. There was no evidence that the patient had an infection at that time. If I felt she was unwell, suffering from severe abdominal pain, it's possible I would have referred her to hospital at that time."

The court heard that, at the time, Dr Maharaj was the only GP at the Elizabeth Street Surgery, and was responsible for around 5,000 patients.

The surgery closed its doors last week following a damning 'inadequate' rating from Care Quality Commission (CQC), which carried out an inspection in May and found evidence that the practice failed to ensure that care and treatment was provided in a safe way , and that leadership was poor.

Last year, an investigation by the Healthcare Safety Investigation Branch (HSIB) also revealed a series of failures at the practice.

Richard Baker, representing Miss Dunn's family, said the court had only Dr Maharaj's word that he had discussed the possibility of an infection with Miss Dunn, as he had not made any notes about it, and had only recorded his concerns about possible anaemia due to blood loss.

He asked the doctor why, if he was indeed concerned about Miss Dunn suffering from an infection, he did not refer her for a hospital test which would have determined whether this was the case.

Dr Maharaj said he did not believe it was necessary based on Miss Dunn's presentation, adding: "At that time in the pandemic, patients were not being transferred to hospital unless there was an absolute need."

Mr Baker, however, said: "I suggest the GP practice was understaffed, oversubscribed and badly organised. You do not accept that being understaffed, oversubscribed and badly organised had anything to do with Sarah's death?"

Dr Maharaj said: "As far as I'm concerned I had no impact on her care."

On April 9, Miss Dunn called the surgery again to request a prescription for painkillers, and complained of nausea, sweating, and abdominal pain. But the pharmacist she spoke to assumed her symptoms were a result of a lack of painkillers, and arranged for a telephone appointment with Dr Maharaj the next day.

She continued to deteriorate, and by the time she spoke with her GP the following morning, an ambulance was already enroute to her house. She was taken to Blackpool Victoria Hospital, where tests revealed high levels of CRP in her blood - a sign of infection.

She died the following day.

Dr Alison Armor, who carried out the post-mortem, said Miss Dunn's infection probably developed as a result of group A streptococcal bacteria in the vagina entering her womb during the termination, which took place on March 23.

She said: "A streptococcal infection, when it becomes invasive, is a rapid and overwhelming infection. Prior to it becoming invasive, it can cause general symptoms of feeling unwell, maybe a high temperature or low temperature. But when it becomes invasive, it is a life-threatening condition.

"I have seen a number of cases of pregnant women who have died after the birth of their babies due to group A streptococcus."

Inflammation found in Miss Dunn's vaginal tract and womb, along with a widespread rash, indicated her condition was 'consistent with the process of medical termination of pregnancy."

Dr Armor said: "It's an unusual but well known complication associated with pregnancy, and can be contracted during or after childbirth, and it has also been documented following termination of pregnancy."

She added: "It should be noted that medical abortion is not recognised as a high risk factor, but cases have been documented within medical records."

The inquest continues.

Sarah's mum, Marie Dunn, said:

"Sarah was a beautiful, happy, loving, caring young lady. She was my second child and was a happy, fun-loving girl. I do not think I can ever come to terms with how cruelly she was taken from us.

"She had a very caring nature and would phone me every day to make sure I was OK... She was a loving sister and foster sister. She even took her brother to live with her when he had a breakdown so he could get back on his feet, which he did. She was a real mother hen.

"Sarah had her whole life ahead of her and we will never accept or come to terms with her loss... My heart will be forever broken for my grandchildren and my family. Sarah's death has brought about a lifetime of change for me and her children and the rest of the family."

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