A 'fit and healthy' mum died while on the phone trying to get a GP appointment. An inquest heard mum-of-two Helena Maffei had been waiting for three hours to get an appointment.
When her GP rang back, Mrs Maffei was having a seizure and her 28-year-old son Giuseppe had dialled 999 for help. Paramedics arrived but were unable to save her and she was declared dead at her Stourbridge Road home, Worcestershire Coroners’ Court heard.
BirminghamLive reports Mrs Maffei, of Kidderminster, collapsed at 2am on the day of her death, but wouldn't let her family ring for an ambulance saying she would call a GP in the morning. She tried calling Kidderminster’s Church Street Surgery at 8.30am on September 23 and was waiting in a queue for over 30 minutes when her phone battery died, the family told the court.
She called again later, and was in a queue for a further 59 minutes before being told a doctor would call her back within 90 minutes. Just over an hour and a half later, her GP, Dr Khatim Niwa, called - but by then, Mrs Maffei’s condition was already severe.
Worcester-born Mrs Maffei, who ran The Continental Bakery with her husband Tony, was prescribed antidepressant drug Sertraline for panic attacks by Dr Niwa two weeks prior. The inquest heard how she quickly deteriorated after starting the medication on September 9 and stopped taking them days before her death.
Sertraline belongs to a family of medications called Selective Serotonin Reuptake Inhibitors(SSRIs), which increase levels of Serotonin in the brain, responsible for a person’s happiness.
Husband Tony Maffei said: “Helena was never ill, not even a cold. She was fit and healthy, walking every day and working 8am to 8pm in the bakery. She didn’t smoke or drink, wasn’t overweight and her diet was very good.
“After two weeks of taking these tablets she became very weak and fragile and had no strength. The side effects of the tablets were all symptoms Helena had during the last days of her life.”
Mrs Maffei suffered gradually increased weakness, heart palpitations, shortness of breath, confusion, sweating, shivering, vomiting and diarrhoea over a period of two weeks, the court heard. A post mortem including specialist tests on the brain and heart could not ascertain the cause of death. No evidence was found of a heart attack or epilepsy and pathologist Dr Sarah Littleford ruled there were a couple of possibilities.
Dr Littleford said: “In my opinion, this is a difficult case. Sertraline can be associated with seizures in individuals developing Serotonin Syndrome.” She said the rare syndrome is a recognised adverse drug reaction that typically 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 displayed by Mrs Maffei. This includes fast 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 cardiac problems or has Sudden Adult Death Syndrome, or SADS.
Dr Littleford said: “I cannot exclude the possibility that Sertraline caused Serotonin Syndrome and death in this case. Neither can I exclude that Mrs Maffei had SADS, which the Sertraline may or may not have exacerbated.”
NHS GP Khatim Niwa told the court there was "nothing she would have done differently", adding that she’d had a good relationship with Mrs Maffei since 2010. The GP said she’d followed NICE guidelines in prescribing 50mg of Sertraline as the mum had been feeling overwhelmed and unhappy with anxiety.
Church Street Surgery, in Callows Lane, run by Wyre Forest Health Partnership, investigated and ruled the death was not due to a delay in accessing care for its service. It found that when Mrs Maffei got through to the call handler, they were professional and the GP had called back in around the 90 minute time expected.
But surgery bosses did acknowledge that there had been an increase in demand for GPs with higher call times. Changes to the telephone system have since been introduced to speed up waiting times for patients trying to get through.
The surgery added that Mrs Maffei had not mentioned collapsing during the night when booking a call with a GP that day.
Sarah Murphy, Worcestershire Assistant Coroner, recorded an Open verdict and said she found no failure to provide basic medical attention or with the surgery’s call handling. She added that extensive measures had been put in place to try to prevent the length of call waiting times at the surgery since.
“There is nothing to say that if the time was reduced, it would have affected the outcome,” said Ms Murphy. “It’s possible but it may not have done.”
Daughter Gaetana Maffei, 31, said: “Mum was very fit so her death was a big, big shock. She was just in her own world. She was not like my mum. She said she’d got no energy and didn’t want to do anything.”
GP surgery conducts review after death
As a result of Mrs Maffei’s death, procedures at Church Street Surgery were reviewed and an investigation carried out by Wyre Forest Health Partnership, which runs the practice along with four others in the Midlands area.
Focus was paid to the call-handling system and changes made to improve phone waiting times. The changes included putting on more staff to handle calls at busier times, more training to use the telephone system better and have shorter calls with patients and identifying peak call times with special software.
Clare Nock, Chief Executive of The Wyre Forest Health Partnership, said: “I’m sorry that it [the call] was that long but that is the sort of call time we are experiencing now. Last September, we were semi coming out of the pandemic and people started to get in touch with us again and demand was significant."
Ms Nock said call waiting times had reduced since Mrs Maffei’s death but were starting to rise again. “They are higher again now than we’d like them to be. Patient demand remains high.
“This is why at the start of our recorded message, we say if it’s an emergency, dial 999. I completely appreciate it’s really difficult for a person or relative to know what’s an emergency but that’s why we try and put it in there.”
