Coroner Finds NHS Neglect Contributed to Young Mother's Sepsis Death
A coroner has ruled that NHS neglect contributed to the death of a young mother from Croydon who died from sepsis after being prescribed the wrong antibiotics. Aleisha Rochester, a 33-year-old bank cashier and mother from south London, passed away two weeks after undergoing a routine procedure to remove an abscess from her left armpit.
Systematic Failures in Antibiotic Prescribing
Assistant coroner Sian Reeves determined that staff at St Epsom and St Helier University Hospitals in West London failed to follow the NHS trust's own guidelines on administering antibiotics. During an inquest held in December, Ms Reeves ruled that Ms Rochester's death had been contributed to by neglect, stating she would most likely have survived if given the correct antibiotics in time.
The coroner detailed how Ms Rochester, who suffered from hidradenitis suppurativa (a condition causing abscesses on the skin), underwent a routine day procedure at St Thomas' Hospital on August 5, 2023. After becoming unwell with an infected wound, she sought medical help multiple times but was consistently prescribed antibiotics ineffective against the bacteria causing her infection.
Missed Opportunities for Correct Treatment
On August 13, 2023, Ms Rochester visited an out-of-hours GP appointment where she received a penicillin-based antibiotic. Later that same day, she attended Croydon University Hospital's A&E department, where doctors diagnosed a wound infection but discharged her with instructions to continue the same antibiotics.
The following evening, she went to St Helier Hospital's A&E department, where she received intravenous flucloxacillin before being sent home with plans to return the next day. When she returned on August 15, a junior doctor, senior house officer, and specialist prescribed antibiotics that did not align with the hospital's antimicrobial guidelines.
The coroner noted critically that the surgical team failed to consult with the hospital's microbiology team before selecting this combination of antibiotics, which did not provide effective coverage against the gram-positive organism most likely causing the infection.
Rapid Deterioration Despite Late Intervention
Although Ms Rochester received a drug on August 16 that complied with hospital guidelines, her condition had already deteriorated significantly. She was admitted to intensive care on August 17 after developing septic shock with multiple organ failure and signs of lung infection.
Despite maximal antibiotic treatment, intubation, ventilation, and intensive medical support, Ms Rochester continued to decline. She suffered a cardiac arrest in the early hours of August 19 and could not be resuscitated.
The coroner specifically ruled that if Ms Rochester had been prescribed the correct antibiotics on August 15, she most likely would have survived. "Her death was contributed to by neglect," Ms Reeves concluded in her verdict.
Family's Devastation and Legal Action
Ms Rochester leaves behind her eight-year-old son, Xavier. Her mother, Lorna, has launched legal action against the NHS trust, describing her daughter as "the most loving, caring and compassionate daughter you could wish for" and an amazing mother with natural parenting instincts.
"There's a huge void in our family," Lorna Rochester said. "The hardest thing to try and come to terms with is how she'll never get to see Xavier grow up and celebrate milestones in life."
The family hopes that by speaking out, they can help improve care for others and raise awareness about the importance of correctly identifying and treating sepsis.
Hospital Trust Apologizes and Implements Changes
Dr Richard Jennings, group chief medical officer for St George's, Epsom and St Helier University Hospitals, stated: "We know we failed Ms Rochester by not giving her the correct antibiotics, with tragic consequences – for this we are extremely sorry and offer our deepest apologies and condolences to her family."
The trust has implemented multiple measures to prevent similar tragedies, including:
- Additional training for staff on prompt sepsis recognition
- Measures to ensure correct antibiotic prescribing
- Regular audits to verify guideline compliance
Madeline Nugent, medical negligence lawyer at Irwin Mitchell representing the family, emphasized: "This is a truly tragic case which has left Aleisha's loved ones devastated. The neglect finding means the coroner was satisfied that there was a gross failure to provide Aleisha with basic medical care."
She added that while it's too late for Aleisha and her family, it's vital that lessons are learned from the failings identified during the inquest.
