A “fit and healthy” mother of two boys has died after suffering a seizure while waiting three hours to speak to her GP, according to an investigation.
Helena Maffei, 55, from Kidderminster, collapsed a day earlier but convinced her family not to call an ambulance, saying she would call the doctors in the morning.
He called Church Street Surgery at 8:30 a.m. on Sept. 23 last year and waited more than 30 minutes in line before his battery died, the court was told.
Ms. Maffei called back and spent just under an hour waiting before being told a doctor would call in 90 minutes.
His GP, Dr. Khatim Niwa, called within the promised time frame, but by then his patient’s condition was serious.
Giuseppe, Ms. Maffei’s 28-year-old son, called 999 when his mother began having a seizure in front of him, but paramedics were unable to save her and pronounced her dead at home.
A post-mortem examination, which included specialized tests on the brain and heart, was unable to determine the cause of death.
But Ms Maffei’s family told the inquest that her condition deteriorated rapidly in the fortnight before her death when she started taking an antidepressant called sertraline for panic attacks.
Sertraline belongs to a family of drugs called selective serotonin reuptake inhibitors (SSRIs), which increase levels of serotonin in the brain, which is responsible for a person’s happiness.
Her husband Tony said: ‘Helena was never sick, not even a cold. She was fit and healthy, walking every day and working from 8 am to 8 pm at the bakery.
“He didn’t smoke or drink, he wasn’t overweight and his diet was very good. After two weeks of taking these tablets, she became very weak and frail and had no strength.
“The side effects of the tablets were all the symptoms that Helena had during the last days of her life.”
The inquest heard that he felt increasingly weak and experienced heart palpitations, shortness of breath, confusion, sweating, chills, vomiting and diarrhea over the two weeks.
Pathologist Dr. Sarah Littleford told the court: “In my opinion, this is a difficult case. Sertraline may be associated with seizures in people who develop serotonin syndrome.’
She said it’s a recognized adverse drug reaction that usually develops within the first few hours and days of using a drug that affects serotonin.
Symptoms range from mild to life-threatening and include many of those shown by Ms. Maffei, such as rapid and irregular heartbeat and seizures.
Sertraline is also known to speed up or change the rhythm of the heart and increase the risk of sudden death if a person is predisposed to heart problems or has sudden adult death syndrome (SADS).
Dr Littleford said: “I cannot exclude the possibility that sertraline caused the serotonin syndrome and death in this case.”
“I also cannot exclude that Mrs. Maffei had SADS, which sertraline may or may not have exacerbated.”
Dr. Niwa told the court that she “would not have done anything different”, adding that she had had a good relationship with Ms. Maffei since 2010.
The GP said that he had followed the NICE guidelines in prescribing sertraline 50mg because the mother was feeling overwhelmed and unhappy with anxiety.
Church Street Surgery, on Callows Lane, investigated and ruled that the death was not due to a delay in accessing care for their service.
He found that when Ms Maffei contacted the call manager, they were professional and the GP had returned the call in around the expected 90 minutes.
But chiefs of surgery did acknowledge that there had been an increase in demand for GPs with longer call times.
Since then, changes have been made to the phone system to speed up wait times for patients trying to get in touch.
The surgery added that Ms Maffei had not mentioned collapsing overnight when she booked a call with a GP that day.
Assistant Coroner Sarah Murphy recorded an open conclusion, saying she found no fault with providing basic medical care or handling surgery calls.
He added that extensive measures have since been put in place to try to avoid lengthy call wait times in surgery.
Ms Murphy said: ‘There is nothing to say that if the time was reduced it would have affected the outcome. It’s possible, but you may not have done it.
Ms Maffei’s daughter, Gaetana, 31, said: “Mum was very fit so her death was a big shock.” She was in her own world.
‘She was not like my mother. She said that she had no energy and that she didn’t want to do anything.
As a result of Ms Maffei’s death, the procedures at Church Street Surgery were reviewed and an investigation was carried out by the Wyre Forest Health Partnership, which runs the practice along with four others in the area.
Attention was paid to the call management system and changes were made to improve phone hold times.
The changes included hiring more staff to handle calls at busy times, more training to better use the phone system and have shorter calls with patients, and identifying peak call times with special software.
Clare Nock, executive director of the Wyre Forest Health Partnership, said: “I am sorry that [the call] it was that long, but that’s the kind of call time we’re experiencing right now.
“Last September, we were coming out of the pandemic and people started contacting us again and the demand was significant.”
Ms Nock said call waiting times had dropped since Ms Maffei’s death but were starting to rise again, adding: “Now they are higher than we would like them to be.” Patient demand remains high.
“That’s why at the beginning of our recorded message, we say if it’s an emergency, dial 999.
“I fully appreciate that it’s really hard for a person or a family member to know what an emergency is, but that’s why we try to put it out there.”
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