Anger after plastic surgery patient, 54, died from undetected heart attack while in Royal Preston Hospital

Lessons learned after a patient died of an undetected heart attack during a stay in the Royal Preston Hospital could save other lives in the future, an inquest heard.

Relatives of 54-year-old Trevor Alan Cornell were assured strict new guidelines have since been introduced to help ensure no-one else is left at risk.

Area Coroner Chris Long was told the retired van driver from Watling Street Road, Fulwood was in a plastic surgery ward at the hospital for an operation on an infected hand caused by his diabetes.

During more than a month in RPH he complained several times of a shortage of breath, but doctors put the symptoms down to asthma or anxiety, both problems he had a history of.

But as he was being prepared to be discharged after surgery he suffered a cardiac arrest while transferring from his bed to a trolley. Despite 40 minutes of CPR he could not be revived.

And it was only realised after his death that the breathing problems had "resulted from complications developed after a recent heart attack," according to consultant pathologist Dr Neil Papworth who carried out a post mortem examination.

He said the heart attack had been caused by a blockage of one of the coronary arteries. He felt there had been an influx of fluid into the sac around the heart and the heart attack was "likely to have occurred at least a day or two prior to Mr Cornell's death."

The inquest heard that Mr Cornell had significant health issues prior to being admitted to hospital for treatment on his damaged hand in mid-January this year. Three days later planned surgery had to be postponed because he wasn't considered well enough for a general anaesthetic.

Despite constant monitoring of his condition consultant plastic surgeon Dr Sankaran Iyer said Mr Cornell did not complain of chest pain and, despite episodes of shortness of breath, there were no issues flagged up which caused the doctors any concerns over heart problems.

One of Lancashire's top cardiac specialists Dr Sarfraz Khan, who is director of cardiology for the Lancashire Teaching Hospitals' Trust, gave expert evidence to the inquest saying that, because an ECG on Mr Cornell showed a deterioration on examinations carried out in the past, the right course of action would have been for the plastic surgery team to refer the patient to the medical team, who would then have called for an echocardiogram scan of his heart and blood tests.

The Coroner said to Dr Khan: "The question I have to consider is if the echocardiogram and blood tests had been carried out, what difference would that have made to the prognosis of Mr Cornell? Would he have lived or lived longer on the balance of probabilities?"

Dr Khan said that if expert cardiac emergency treatment had been carried out it "could have lessened the pressure on the heart." He added: "That would have led to a significant improvement in his breathing. Things could have been done to improve his symptoms and improve the prognosis.

"We all have to die one day. But this acute condition could have been managed more appropriately."

Dr Iyer said that since Mr Cornell's death special measures had been brought in to ensure that teams like plastic surgery and medical talk regularly on a consultant to consultant level so that a repeat of this tragedy can be avoided.

Coroner Long summed up: "This is really important. Those from the plastic surgery team might not have identified a problem with the ECG, but they should have referred it to the medical team. Dr Khan says it is more likely than not that the medical team would have identified it and it would have resulted in intervention that is likely to have made a difference to Mr Cornell's prognosis."

He said he would not be writing to the hospital to demand improvements be made because they had already been instigated in the wake of this case.

"I am satisfied Mr Cornell had a heart attack some days before he eventually died. It is not my job to attribute blame. The reason they (plastic surgery) did not refer him to the medical team is based on their experience. They considered the root cause was likely to be asthma or anxiety.

"It is likely that had he had that (referral and subsequent medical intervention) he would have been treated and either he would have lived or lived longer."

He added that with the new processes in place it would "hopefully prevent that happening again."

And speaking to the family he said: "What has happened to Mr Cornell in my view will result in lives being saved in the future. I know it's bitter sweet, but lessons have clearly been learned."

Relatives said after the inquest they were "angry, very angry."