Retired GP's death 'avoidable' if cause of severe chest pain was 'more thoroughly investigated'

Senior Coroner David Heming heard that former GP Jacob Hassan, 62 and of Cambridge, was rushed by ambulance to Addenbrooke's Hospital’s emergency department in the early hours of 30 April 2018 after the significant chest pain developed.

He was examined by an emergency doctor who explored various possible reasons for the pain.

An inquest concluded the death of retired GP Jacob Hassan could have been avoided. He is pictured with his grandchild. (Image: TEES LAW)

One possible source of Jacob’s pain was a life-threatening condition called aortic dissection, in which the main artery that carries blood away from the heart develops a tear enabling blood to leak into the aortic lining.

This can create a false channel between the inner and outer layers, raising the risk of life-threatening consequences.

Although aortic dissection was considered as a possibility, the emergency doctor did not order a specialist scan called a computed atomography (CT) aortogram.

This could have been quickly performed on-site and is the definitive test for aortic dissection and other circulatory disorders.

An inquest concluded the death of retired GP Jacob Hassan could have been avoided. (Image: TESS LAW)

The Coroner’s Record of Inquest noted that Jacob: “…underwent a number of investigations initiated by a nurse and a doctor.

"These included blood tests, an ECG, a chest X-ray and a point of care ultrasound.

"Following clinical examination by a doctor, he was discharged home at circa 03:04 with a diagnosis of non-specific chest pain”.

The emergency doctor thought he may have had oesophagitis.

Jacob, who loved visiting his children and grandchildren in Indonesia and Australia, had been sent home from Addenbrooke’s without a CT aortogram being undertaken.

The decision not to pursue further the clear possibility of aortic dissection and to perform remedial surgery was disastrous for Dr Hassan as on May 1, his wife Sharon found him collapsed at home.

A post mortem revealed that the primary cause of death was a cardiac tamponade (fluid accumulation) due to haemopericardium, resulting from thoracic aortic dissection.

The coroner’s record added: “The presentation of chest pain being severe, sharp, and radiating to his back was indicative of acute aortic syndrome, specifically thoracic aortic dissection and should have triggered CT aortography at the hospital which would have confirmed the presence of such a dissection.

"This would have necessitated emergency cardio thoracic surgical intervention and on balance, Jacob would have survived such a procedure.”

The coroner concluded that, based on the post mortem examination and independent inquest evidence from medical experts, Jacob died from cardiac tamponade due to a ruptured aortic dissection (Type A), which had not been positively excluded as a differential diagnosis during a hospital clinical examination “because a CT aortogram had not been undertaken”.

When she had first learned the cause of her husband’s death and the fact that an appropriate scan could have led to correct diagnosis and probably successful surgical intervention, Sharon Hassan became motivated to raise awareness of how effectively CT aortograms can identify dangerous circulatory disorders and so save lives.

“Mrs Hassan has been determined in her quest to raise awareness for more frequent CT Aortograms,” says specialist solicitor Tim Deeming of Tees Law, acting for the family.

"It is some comfort that Cambridge University Hospitals NHS Foundation Trust confirmed at the inquest that since her husband’s tragic death there has been a 250 per cent rise in the number of CT angiograms being performed.

“We want to ensure that there is a lasting and consistent legacy for Jacob and raise the widest possible awareness of aortic dissection and the threat to life that it poses, when such investigations are relatively quick and should become the required standard.

"Jacob died in 2018 despite a 2015 petition following a sad death in similar circumstances in Bristol which had prompted the creation of www.thinkaorta.org,

"It campaigns to save lives ‘by increasing the identification and early diagnosis of aortic dissection in Emergency Medicine.

"Some of its 6,000-plus supporters have also lost loved-ones through undiagnosed aortic dissection, so there is still much work to be done nationally to ensure that there is greater consistency throughout.”