A dad who died in agony from sepsis waited five days for delayed treatment and wasn't given the right drugs.
Father of two Simon Smith was admitted to hospital in July last year with a searing pain in his leg.
During his stay members of staff at Russells Hall Hospital in Dudley, West Midlands failed to give him antibiotics on several occasions.
The 51-year-old was displaying classic signs of the illness - which claims 51,000 lives in the UK each year - including a high temperature and a raised heart rate.
Staff initially gave him pain killers and pledged to return with antibiotics if his condition deteriorated, hospital notes reveal.
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A 38-page report into his treatment indicates he was not given the drugs until he began suffering from multi-organ failure five days later.
His condition was so serious Mr Smith, an installer, was taken into intensive care where he spent three months before being discharged in October.
Having not fully recovered a fortnight later he returned to hospital and on November 1 died.
His widow Hayley, who worked at the hospital as a data collector for 16 years, told the Daily Mail: "I have lost everything. He was my best friend and my husband for 25 years.
"All they gave him for five days was painkillers – he was in the worst pain he had ever felt, his temperature was spiking."
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A report into Mr Smith's death reveals a string of failures prior to his death.
He was diagnosed with osteomyelitis - an infection in the bone in his leg - which triggered sepsis , a violent immune response which attacked his organs.
As well as poor record keeping, a lack of communication and a failure to act on his deteriorating condition, the investigation found seven occasions when antibiotics should have been administered.
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Dudley Group NHS Trust has been under fire over how it dealt with the issue.
After the Care Quality Commission suggested senior consultants resented the NHS focus on sepsis, Health Minister Caroline Dinenage criticised the hospital doctors for showing a "frankly unacceptable" attitude.
Diane Wake, chief executive of the trust, offered her "heartfelt condolences" and said the review had "highlighted significant areas of learning".
She also pointed to the fact that sepsis deaths had fallen at the hospital in the past four years.
Russell Halls has now commissioned an investigation into 229 deaths at the hospital.
