Serious concerns raised after 23-year-old suffering from Covid died after long wait for ambulance

By Tara O’Connor, local democracy reporter

A 23-year-old who was so ill with Covid-19 he could hardly speak died after an eight hour wait for help at the start of the pandemic.

A coroner has now called for national changes in a prevention of future deaths report after the death of Richard Boateng in Croydon.

Richard called his GP surgery feeling “very unwell” on March 30, 2020 but was only offered a routine appointment by a receptionist.

By the time he was called back by a GP the next morning (March 31) he was unable to complete sentences or give his full name.

The GP called an ambulance, but Richard was not at home, he was on a bench in the street from at least 10.30am.

When paramedics arrived at his home to find him not there they told his sister to call the police.

Police got to Richard at 4pm and a second ambulance didn’t arrive until 6.23pm.

He was taken to Croydon University Hospital and died that evening despite attempts to resuscitate him.

An inquest into his death concluded on September 24 by Jonathan Landau, assistant coroner for South London, has published prevention of future deaths report.

It was sent to NHS England, London Ambulance Service (LAS) and the College of Policing which all have 56 days to respond.

In the report the coroner lays out his concerns and says there is a risk future deaths could happen without action.

About NHS England, he writes: “I am concerned that other surgeries may employ non-clinicians who may be required to make judgements as to the urgency of appointments, and there is no guidance available to surgeries as to how to mitigate the risks of this.”

In Richard’s case, the receptionist who took his call was not a clinician and the surgery has since introduced a system which flags emergency or urgent calls using an algorithm based on questions.

In relation to the LAS, Mr Landau said that in this case it would have been better for the paramedic to take the sister’s number and pass it on to police. He says guidance to ambulance crews needs to be updated to reflect this.

During the pandemic Met Police had a policy that officers could take patients to hospital if no ambulances were available.

Mr Landau says there was “no practical guidance” about how this could be done.

He wrote: “I heard that the Metropolitan Police Service is updating the guidance.

“However, I am concerned that other forces across the country may also lack such practical guidance, which is of particular concern due to the ongoing pandemic and the demands that may continue of ambulance services.”

An NHS spokesperson said: “The NHS sends sincere condolences to the family affected and will respond in the usual way within the time frame set by the coroner.

“Individual GP practices are responsible for training their staff in patient triage and assessment systems.”

A spokesperson for Metropolitan Police said: “The death of Mr Boateng was a dreadful incident and the thoughts of the Met are with his family and friends.

“In relation to the case of Mr Boateng and if he should be transported in a police vehicle, the decision was dynamic and remained under constant review.

“When it appeared the condition of Mr Boateng was deteriorating and that police transport should be utilised, the officers were informed that an ambulance was being assigned and he was subsequently taken to hospital by ambulance.

“There was no criticism made of the actions of the officers who attended, who clearly explained to the inquest the rational for their actions at a very difficult situation.

“It must be remembered that police officers are not trained to the standards of paramedics and their vehicles are not designed to transport the ill or injured, nor are police vehicles equipped to deal with serious medical emergencies.

“For these reasons, it is only in exceptional circumstances that a police vehicle should be used.

“In appreciation that these cases require a dynamic risk assessment at the scene, the Met had previously amended their policy so that a Duty Officer would no longer be the arbiter of whether a police vehicle will be used to transport those ill or injured; it is now for the driver of the police vehicle attending to make the decision

“A Preventing Further Death report was sent to the College of Policing for national consideration.

“The Met has also decided to explore the practical issues that arise in these cases and what support and guidance can be given to officers dealing with such critical incidents.”