DOCTORS failed to spot a fractured rib that led to the death of a Hampshire diabetes sufferer, an inquest heard.

Jean Phyall, 79, died at Royal Hampshire County Hospital in Winchester of injuries likely to have been caused by a fall, after medics had missed giving her an insulin injection.

She suffered a hemothorax, where blood collects in the space between the chest wall and the lung, but the fractured rib was not diagnosed.

She was discharged from hospital but re-admitted two weeks later with severe chest pains, the inquest was told. The fractured rib was missed again despite an x-ray being taken and Mrs Phyall, of Nursery Road, Chandler’s Ford, died on March 23, four weeks after the fall.

The inquest heard the failure to give her the insulin dose was due to an omission by a doctor. However medical consultant Dr Jimmy Chong said this would have not caused Mrs Phyall’s fall on February 24.

She had first been admitted to the hospital on February 21 feeling unwell and confused. She was diagnosed with an acute complication of diabetes and treated with antibiotics and intravenous fluids. 

Her widower, John Phyall, told Winchester Coroner’s Court that the management of her diabetes at the hospital had been “pretty hopeless”.

A postmortem by pathologist Dr Adnan Al-Badri revealed there was a fracture of the 10th rib and blood in the chest cavity around the lungs of Mrs Phyall. He gave the cause of death as a hemothorax.

Dr Chong told the inquest that the hospital had carried out education sessions for staff on the topic of diabetes and the importance of insulin injections since Mrs Phyall’s death.

Senior Hampshire coroner Grahame Short recorded a verdict of accidental death.

Mr Short said: “If it had not been for the fall on February 24, I do not believe she would have died and the hemothorax was the prime reason for her death.
“Jean was an insulin dependent diabetic. On February 24 one of her doses of insulin was missed as a result her blood sugar was raised and she sustained a fall as a result of which she suffered a fractured rib which was not recognised at the time.”

He added that if the hemothorax had been diagnosed sooner then the blood thinning treatment she was on may have been stopped, which may have helped.

Mary Edwards, chief executive of Hampshire Hospitals NHS Foundation Trust, which runs the Royal Hampshire County Hospital, said: “I would like to offer my sincere condolences to the family and friends of Jean Phyall.

“We co-operated fully with the inquest leading to the coroner’s conclusion of accidental death. Our sympathies are with Mrs Phyall’s family at this sad time.”