The daughter of a former England cricketer died from sepsis and pneumonia after paramedics failed to alert doctors to her symptoms, causing her to suffer an avoidable fatal heart attack.
Bethan James, whose father is the former Glamorgan and England cricketer Steve James, a cricket and rugby writer for The Times, died aged 21 on February 8, 2020, after weeks of “dismissive” hospital visits left her reluctant and unwilling to attend University Hospital Wales (UHW) in Cardiff at the request of medics in the days before her death.
An inquest into her death was told that her family called 999 on the evening of February 8 after she collapsed while going to the bathroom, but the first rapid-response paramedic to attend the family home in Cardiff failed to spot the signs of life-threatening sepsis and made only a non-urgent request for an ambulance.
Bethan as a baby with her parents, Jane and Steve
HUW EVANS/PA
When the ambulance crew arrived they failed to alert the hospital to Bethan’s serious condition, which the Welsh Ambulance Service later acknowledged should have happened.
This meant that emergency doctors were not alerted to her arrival at the hospital and, instead of being sent to the most serious resuscitation area, she was sent to a less urgent “majors” zone of the emergency department for more than an hour.
She was moved to resuscitation only after tests revealed the seriousness of her condition. She suffered a fatal heart attack about 15 minutes later.
Patricia Morgan, the coroner, concluded that “on balance I find Bethan would not have died” if the delays in her treatment on February 8 had not occurred.
“The number of delays in her treatment more than minimally contributed to her death,” Morgan added.
Bethan had been studying journalism at the University of South Wales
Delivering a narrative conclusion, the coroner said: “If early recognition and prompt action had occurred, this would have resulted in a pre-alert to the emergency department and direct admission to resus [resuscitation] and a quicker triage process.
“Early lactate readings [a marker for sepsis] would have been available and involvement of other specialists would have occurred.
“On balance I find had this direct admission to resus and prompting occurred then cardiac arrest would not have occurred when it did, which would have allowed more time to treat her symptoms.”
In a statement read after the conclusion, Bethan’s parents said: “It is heartbreaking for us to know that with appropriate treatment Bethan would not have died … [she] had a brilliant and full life ahead of her but it was taken away by a catalogue of errors that could so easily have been avoided by better listening, understanding, recognition and actions by healthcare staff.
“Sepsis is still not spotted quickly enough and this was a tragic example.
“We are glad that the Welsh Ambulance Services NHS Trust have at least admitted some of their failings but we are deeply disappointed and distressed that the Cardiff and Vale University Health Board has not done the same. It has become a cliché that the NHS is broken but this was a case in point because the care given to Bethan was simply unacceptable.”
Bethan, from Cardiff, had suffered with gastrointestinal issues for most of her life, before she was diagnosed with Crohn’s disease in 2019 at the age of 20.
She had been studying journalism at the University of South Wales and dreamed of being a voice for those with Crohn’s and related illnesses. She had started a vlog account where she documented her experience of the condition, before she became involved in a BBC documentary, which eventually aired after her death and was dedicated to her memory.
Hr father was away covering a Six Nations rugby match in Ireland when his daughter was taken seriously ill, and because of weather delays was unable to get home and see her before she died.
Jane James, her mother, said their daughter had been “dismissed” by multiple medics in the weeks before her death, as she first suffered tiredness and shortness of breath on January 25, 2020, which quickly developed into severe numbness and involuntary movements in her right arm, difficulties using her right arm and hand, abdominal pain and nausea to the point of being unable to tolerate food.
Carys Williams, the nurse in charge of resuscitation that day, said if staff had been alerted before Bethan’s arrival it would have “rung alarm bells” and triggered a discussion with the consultant.
The family said sepsis training and recognition of symptoms needed to “improve dramatically” and healthcare staff needed to “admit their mistakes so that lessons can be learnt”.
They said Martha’s Rule in England, named after Martha Mills, who also died of sepsis when her family’s concerns were not listened to, provided patients and families with a way to seek an urgent review if their or their loved one’s condition deteriorated and they were concerned this was not being responded to. They urged the Welsh government to implement Martha’s Rules across the NHS in Wales.
Last year early NHS data showed nearly one in eight calls under the Martha’s Rule scheme had led to potentially life-saving changes in patient care.
At least 573 calls were made in September and October 2024, with half requiring a clinical review for acute deterioration. Of those, one in five led to a change in the patient’s care, such as receiving antibiotics or oxygen, and a further 14 calls resulted in a patient being transferred to an intensive care unit.
The coroner gave the cause of death as sepsis caused by pneumonia, likely virus, with Crohn’s disease as a contributing factor.
She asked Cardiff and Vale University Health Board to provide a statement within seven days on why practices in England that could have saved Bethan’s life were not routine in Cardiff.