Neglect played part in death of Billingham student labelled ‘time-waster’, says coroner
A normally fit and healthy law student who died in agonising pain was made to feel like a “time-waster” by medics, a coroner has found.
Libby Instone, 20, from Billingham, died as a result of an infarction of her small intestine in August 2023.
She previously went to an urgent care centre three times in just over 24 hours and was admitted and released from hospital where she was incorrectly treated for gastroenteritis.
Teesside Coroner Clare Bailey, found neglect by medics contributed to the Newcastle University student’s death at an inquest in Middlesbrough.
Mrs Bailey said: “In Libby’s case, the failure to consider anything other than gastroenteritis despite Libby enduring four days of vomiting and agonising abdominal pain constitutes gross failures in her care.”
This was compounded by infrequent physical checks, incorrect recording of vomiting and a lack of basic care, Ms Bailey said.
“In Libby’s case, the failure to consider anything other than gastroenteritis despite Libby enduring four days of vomiting and agonising abdominal pain constitutes gross failures in her care,” the coroner said.
This was compounded by infrequent physical checks, incorrect recording of vomiting and a lack of basic care, Ms Bailey said.
Recording a narrative conclusion, the coroner said Libby repeatedly visited North Tees Hospital Urgent Care Centre (UCC) in Stockton and was later admitted to hospital prior to being discharged home, later suffering a cardiac arrest.
“There were missed opportunities to investigate the cause of her persistent abdominal pain and vomiting, and to provide life-saving treatment,” she said.
“Libby’s death was contributed to by neglect.”
Her family claimed hospital staff were pre-occupied watching a penalty shoot-out in the women’s World Cup on TV when they went to visit her.
Libby was allowed home later that day but still felt very ill and collapsed and died soon after.
In the days after her death, the family said they were told by the hospital that Libby could not have been saved.
But a report by an independent medical expert found multiple chances were missed for a scan of Libby’s stomach to be done, and that an operation could have successfully treated her blocked intestine.
Mrs Instone said: “My daughter’s last few days of life were horrendous. Libby was in constant agony, she was scared.
“We were to hospital trusting in the people we believed would look after her but Libby was let down by doctors who were meant to take care of her.
“Libby was treated as an annoyance, a time-waster and was never shown any compassion.”
Dr Michael Stewart, group chief medical officer for North Tees and Hartlepool and South Tees Hospitals NHS Foundation Trusts, told the inquest he offered “an unreserved and sincere apology for the missed opportunities in Libby’s care”.
The coroner accepted procedures have improved at the trust.
The North Tees and Hartlepool NHS Foundation Trust apologised to Libby’s family and said a “thorough review” of the circumstances identified shortcomings in Libby’s care.
A spokesperson said: “We are deeply saddened by the death of Libby Instone who was under our care.
“Our sincere condolences remain with her family, friends and loved ones during this difficult time. We accept the findings of the inquest today.
“We are committed to learning from this tragic case and have implemented measures to strengthen processes to reduce the risk of similar incidents in the future”.