Diabetic died after 'flat lemonade' advice

An NHS Direct doctor said classic signs were missed

A diabetic died only hours after an NHS Direct nurse said she should be treated with flat lemonade and paracetemol, an inquest was told.

Roma Wooldridge was slipping into a coma when the nurse called back and said: "Let her have a good sleep now, okay?"

The inquest jury at Plymouth, Devon, has heard her chances of survival would have increased significantly if she had been taken to hospital.

The medical director of NHS Direct told the inquest jury that classic signs were missed and basic questions not asked.

Donna Wooldridge had phoned the government-funded helpline from her mother's Plymouth home at 3.30 BST on 18 April.

A supposedly experienced healthcare professional ignored or didn't appreciate several classical signs

Dr Gillian Bryce, NHS Direct

Sixty-year-old Mrs Wooldridge had been sick for three days and had barely eaten.

Donna told NHS Direct nurse adviser Jackie McDevitt that her insulin-dependent mother had been seen by her GP.

She had been given tablets to stop the nausea, which appeared to have gone.

But she said her mother's temperature fluctuated wildly, she was restless and hallucinating, and her blood-sugar readings swung between very high and very low.

Return call

The inquest jury heard a tape of NHS Direct nurse Jackie McDevitt suggesting flat Coke or lemonade, plenty of fluids, and paracetemol.

The nurse called back as arranged at 06.00 BST, by which time Mrs Wooldridge was already slipping into a coma.

Eventually a neighbour urged Donna to call an ambulance crew, but she was dead by 09.00 BST.

The telephone takes away the ability to spot if a patient is ill.

Professor Andrew Hattersley, diabetes specialist

Dr Gillian Bryce, a medical director of NHS Direct Westcountry, said the consultation by the nurse advisor was "random and unstructured".

She said: "A supposedly experienced healthcare professional ignored or didn't appreciate several classical signs."

The nurse appeared to have recognised that Mrs Wooldridge might have ketoacidosis, a chemical imbalance caused by lack of insulin.

But her advice to drink flat Coke or lemonade was wrong, Dr Bryce said on Tuesday, the second day of the inquest.

Confusion risk

Professor Andrew Hattersley, a diabetes specialist at the Royal Devon and Exeter Hospital, was critical of NHS Direct.

He said: "The telephone takes away the ability to spot if a patient is ill, which we rely on as a sixth sense rather than taking guidelines by rote."

There was a possibility of confusion in NHS Direct's guidelines, which put too much emphasis on vomiting and nausea, he said.

Paul Barker, representing NHS Direct, said its guidelines on diabetes had been changed since, but not because of Mrs Wooldridge's death.

Missed test

Dr Nicholas McCarthy, an expert medical witness, said Mrs Woolridge's GP, Dr Ellen Loopstra, should have tested for ketoacidosis.

He said: "This was an unacceptable departure from acceptable practice."

But he acknowledged that many GPs may have missed the test.

Dr Loopstra said Mrs Wooldridge had no symptoms of ketoacidosis and she did not consider her particularly unwell.

The hearing continues.