A 45-year-old father of two tragically died from sepsis after waiting 34 hours for intravenous antibiotics at Bassetlaw Hospital in Nottinghamshire. The disabled man, who suffered from the rare neurological condition Alexander disease, was admitted for treatment of a urine infection resistant to oral antibiotics.
An investigation by the Parliamentary and Health Service Ombudsman (PHSO) found that delays in administering the correct antibiotic treatment contributed directly to his death, which ultimately could have been prevented.
Living in supported accommodation in Ollerton, Nottinghamshire, the man faced significant health challenges, including respiratory and mobility issues, requiring constant care and assistance with feeding and personal hygiene. His condition necessitated a permanent catheter, making him highly susceptible to urinary tract infections. In November 2022, after contracting an infection, his GP referred him to Bassetlaw Hospital for intravenous antibiotics.
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The PHSO investigation revealed that the hospital administered the appropriate IV antibiotics more than a full day after his arrival—and at only half the required dosage. The second dose was also delayed, and by that time, the man had developed sepsis and passed away a week later.
Communication barriers stemming from his disabilities made it difficult for him to express concerns or alert staff about the lack of treatment. His mother raised urgent concerns with hospital staff, but she was not informed that her son had not yet received the antibiotics. Additionally, paramedics and care home staff had communicated that he required IV antibiotics, but hospital medics chose to attempt oral medication, which was contraindicated and unavailable. The failure to seek further microbiological advice contributed to treatment delays.
Following the PHSO’s recommendations, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has agreed to apologize formally, compensate the family, and implement an action plan to prevent similar incidents in the future.
The man’s mother expressed her heartbreak: “I knew my son better than anyone and tried to help the doctors by telling them the oral antibiotic wouldn’t work. But they dismissed me, acting as if they were the experts and I was just his mum.” She added, “It was devastating to learn he received no treatment for so long. Though it won’t bring him back, holding the trust accountable has given me closure and I hope others won’t endure the same pain.”
Karen Jessop, chief nurse at the trust, said: “We are truly sorry for the loss and have reviewed the care provided. Immediate steps have been taken to improve how antibiotics are prescribed and administered.”
PHSO chief executive Rebecca Hilsenrath emphasized the urgency of addressing systemic problems: “Losing a life to sepsis should not be inevitable, yet complaints have doubled in five years. Poor communication remains a persistent issue, and we are working to improve patient-clinician interactions across the NHS.”