Young Logan Jones died after meningitis wasn’t picked up by doctors at Royal Gwent Hospital in Newport.
The eight-year-old boy went to hospital twice while suffering with the killer infection, but was “completely failed”, a coroner said.
He died hours after leaving hospital for the second time on November 19, 2019, with his mum tragically finding his body when she went to give him some water.
The inquest into his death heard a statement read out from Logan’s mum Michelle Allen, Wales Online reports.
She described her son as a “very happy child” who was very close to his sister.
Logan had been born with a heart defect and a genetic condition called Chromosome 14, which lead to learning difficulties.
In her statement Ms Allen relived how Logan first started feeling unwell on November 15, 2019.
He had a headache, felt sleepy and vomited, the inquest was told.
The heartbroken mum explained she had called for help the next day and was told to take the little boy to A&E.
When they got to hospital the youngster was triaged and had his vital signs checked by nurses and an ambulance crew, before he was seen three hours later.
A junior registrar with four months paediatric experience saw Logan, but did not spot any key symptoms of meningitis, thinking he had a “viral illness”.
He told the inquest he didn’t consult with anyone more senior as he “did not think it was necessary”.
The doctor said he offered to keep Logan in hospital for checks but Ms Allen said she would take him home and bring him back if he got worse, the coroner was told.
However Logan got worse the following day, with his GP referring him back to the Royal Gwent.
Ms Allen told how she arrived to “chaotic” scenes at what was then the Child Assessment Unit.
She said: “I asked for a bed as Logan was wanting to lie down, which he could not do in the waiting room. [I was] told he could not, he would have to stay in the waiting area…as Logan was wanting to lie down and the department was chaotic.”
Ms Allen told how she asked how long they might be waiting and was told it was “busy”, so with no idea when her son – desperate to lie down – might be seen she took him home.
She added: “We got him to bed [at around 10.30pm]. Logan said to me: ‘See you’ and I replied: ‘Love you’.
“I woke up at 3.50am and decided to give Logan some water. He was lying there…I touched him, he was stiff, and I started screaming.”
The little boy was tragically pronounced dead at 4am, with his death recorded as pneumococcal meningitis.
The inquest heard from Dr William Christian, who said he thought the junior doctor had given a “very brief assessment for a child with complex needs”.
What are the symptoms of meningitis?
The symptoms of meningitis develop suddenly and include:
- A high fever over 37.5 degrees – the average human temperature
- being sick
- a headache
- a blotchy rash that doesn’t fade when a glass is rolled over it
- stiffness, especially in the neck
- sensitivity to bright lights
- drowsiness, irritability or lack of energy
- cold hands and feet
He added that from the notes there was no record the doctor had not found Logan to have a stiff neck or was sensitive to light – key signs of meningitis.
Discussing the second hospital visit, Dr Christian said if Logan had been seen by a doctor earlier he would have likely been kept overnight.
But he noted the infection can cause a quick deterioration, so he could not be certain of a different outcome even if that had happened.
Senior coroner for Gwent, Caroline Saunders, said it had been a “broken system” and Logan’s mum’s decision to go home was the “lesser of two evils”.
Ms Saunders said: “Had Logan remained in hospital overnight his deterioration would have been [observed] and staff would have been offered an opportunity to save his life.”
She added he was “completely failed” but she couldn’t be sure if the experience directly contributed to his death – therefore recording a conclusion of natural causes.
The inquest heard a number of changes have been made, with leaflets handed out to people coming to the centralised unit at the new Grange Hospital.
Susan Dinsdale, assistant divisional nurse, said patients and loved ones are now advised not to leave without speaking to a nurse.
Those who do leave without being seen are now called in a follow up as standard practice.