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The Guardian - UK
The Guardian - UK
Jon Ungoed-Thomas

Why didn’t wife and mother get ‘miracle’ stroke treatment, grieving family ask

Satinder and Jasbir Pahal. Jasbir died last November after a stroke.
Satinder and Jasbir Pahal. Jasbir died last November after a stroke. Photograph: Family Handout

A primary school teaching assistant died from a stroke after hospital staff told her family that the life-saving treatment she needed was not available at weekends.

Jasbir Pahal, 44, who had four children and was known as Jas, died in November last year after suffering a stroke. Her family was told she could only be treated with aspirin because a procedure to remove the blood clot was only available from 8am to 3pm, Monday to Friday.

It has now emerged that the life-saving treatment, called mechanical thrombectomy, was available at an NHS hospital trust just a 40-minute drive away from the Calderdale Royal hospital in Halifax where she was being treated, but there were no arrangements for such transfers.

Jasbir’s husband, Satinder Pahal, 49, said: “We have paid the ultimate price for this deficient service. Despite our pleas to save Jas’s life, all they could do was to give her an aspirin.

“My wife was a vegetarian, never drank alcohol or smoked. She was fit and healthy and she wasn’t given the chance to survive. Jas was the centre of our worlds and her loss will impact us for ever.” The family are calling for urgent action to prevent future deaths.

The Observer reported last month of warnings by the Stroke Association charity and clinicians about the regional variations in access to mechanical thrombectomy. It has been described as a “miracle” treatment, with some patients who were at risk of death or permanent disability walking out of hospital the day after the procedure.

Mechanical thrombectomy involves inserting a small wire and tube into an artery and manoeuvring them towards the brain to pull out the clot. The procedure is suitable for blockages in larger arteries.

Jasbir suffered a stroke overnight on the weekend of 12-13 November last year and her husband called for an ambulance in the early hours of Sunday morning. It should have arrived in 18 minutes under average target response times, but it took more than an hour to get to her family home in Huddersfield.

On arrival at hospital in Halifax, Pahal was given a CT scan that identified a blood clot suitable for “intervention”, such as clot-busting drugs or mechanical thrombectomy. The family was told too much time had elapsed to give clot-busting drugs and that the mechanical thrombectomy service at nearby Leeds General Infirmary was not available at weekends.

It was proposed Jasbir was given aspirin and monitored by medical staff, according to medical records examined by Fieldfisher, the legal firm representing the Pahal family.

Satinder was distressed that his wife was in such a serious condition and repeatedly asked hospital staff why more was not being done to help her. It is claimed he was warned that security would be called if he did not stop challenging hospital staff.

Just 32 miles away, the Salford Royal hospital provides a 24-hour, seven days a week mechanical thrombectomy service that could have saved Jasbir. It appears there were no arrangements in place for transfers to the hospital.

A family member – an NHS surgeon in a London teaching hospital – made numerous calls to the hospital in Halifax on the morning of 13 November, urging staff to arrange a transfer. The relative also phoned a stroke consultant at Leeds General Infirmary to try to arrange a thrombectomy outside the normal protocols.

A transfer was then arranged to Leeds, but the ambulance was delayed and Jasbir did not arrive until 9.10am, more than seven hours after the first 999 call. Husband Satinder was told that the time lapse between the stroke occurring and Jasbir arriving at Leeds meant the brain damage was irreversible and any invention might cause more brain damage.

Jasbir’s condition continued to deteriorate and she died on 30 November. An inquest is due to be heard in Wakefield on 24 October.

Helen Thompson, a solicitor at Fieldfisher representing the family, said: “The family believes Mrs Pahal wasn’t afforded the right care, within the right time period, at the right place, and that the relevant pathways were not in place to give her access to 24/7 thrombectomy.”

Thompson said the West Yorkshire Integrated Care Board had not commissioned a stroke service to ensure that patients could be referred to hospitals outside the region for a thrombectomy.

Juliet Bouverie, chief executive of the Stroke Association, said there was a “postcode lottery” over access to mechanical thrombectomy. She said: “It is a tragedy every time an eligible patient misses out. We must see urgent progression to 24/7 access across the UK.”

Calderdale and Huddersfield NHS foundation trust, which was responsible for Jasbir’s care at Calderdale Royal hospital, said: “We are aware of this case and have provided evidence to the coroner. We will cooperate fully with the inquiry. It is inappropriate for us to provide further comment until the inquiry has concluded.”

A spokesperson for Yorkshire Ambulance Service NHS Trust said: “We would like to express our deepest sympathy to the family of Jasbir Pahal. We are aware of the concerns raised by Jasbir’s family and our patient relations team is liaising directly with them.

“The trust is contributing fully to the forthcoming inquest and is unable to comment further at this stage.”

West Yorkshire Integrated Care Board said the rollout of mechanical thrombectomy services was being led by NHS England.

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