OXFORDSHIRE’S ambulance service has admitted a series of failures which a doctor said may have led to a pensioner’s death.

And last night the South Central Ambulance Service (SCAS) apologised for distress caused to 76-year-old Clive Gould’s family.

Mr Gould died after waiting an hour-and-a-half for an ambulance, despite his wife making five 999 calls.

Now SCAS has produced a report admitting Mr Gould’s case was given the wrong priority rating, which meant two ambulances which were sent to him were diverted to more important calls.

Speaking at an inquest into his death on Wednesday, pathologist Dr Ben Phillips said there was a “definite possibility” that had the ambulance arrived 30 minutes earlier, Mr Gould might have survived.

Mr Gould’s widow, Sheila, 73, said: “It was dreadful. He was gasping for breath.

Herald Series:

Clive Gould’s widow Sheila and son Stephen.                                             

“This was a breakdown in communication. I’m not a person to complain, but the NHS has let me down.”

Retired lorry driver Mr Gould, 76 – originally from Witney – was diagnosed with lung cancer in April this year and started chemotherapy in May.

He also had emphysema and other lung and heart problems.

On July 18, he woke up at about 3am in the house he shared with his wife in Filkins, near Carterton, with breathing problems.

Mrs Gould first called for an ambulance at 4.18am and her call was given a ‘code amber’, meaning an ambulance was due within 20 minutes.

SCAS investigations manager Paul Cooke, who investigated the family’s complaints into the incident and produced the report, told the inquest that an ambulance was ordered from Bicester at 4.20am. But it was diverted at 4.29am to reports of a seizure.

Mrs Gould called again at 4.59am and was put through to a clinical specialist to describe the symptoms in greater detail.

Another ambulance was sent at 5.11am but this, too, was diverted to a higher priority ‘code red’ to deal with reports of someone having chest pains.

At 5.22am, a third ambulance was dispatched, which arrived at 5.46am.

Mr Gould, who had been awake and  talking at the time of the first call, was at this time unresponsive and, after half an hour of CPR, was declared dead.

The coroner at his inquest gave a narrative verdict and ruled Mr Gould died of congestive cardiac failure – a build-up of fluid in his heart.

In the SCAS investigation, Mr Cooke explained that Mr Gould had been given an “amber” code but that in hindsight that was wrong.

Mr Cooke also said that had emergency call takers followed the correct process, information about Mr Gould’s deteriorating condition could have been recognised earlier and added: “There does not seem
to be any resilience in the system to tolerate unfilled or unallocated units not covered, or sudden sickness.”

He also said that three staff were sick that morning.

Coroner Nicholas Graham ordered SCAS to review the way it treats emergency calls and its assessment process.

He said: “It is not possible to say whether the deceased would have survived had he been treated earlier.”

Mr Gould’s daughter Christine Tinson, 52, who lives in Filkins, said following the inquest: “I am disgusted with the service we got.

“We could have driven to the hospital if we knew what was happening.”

His 51-year-old son Stephen said: “We know they made a mistake.”

A SCAS spokesman said yesterday: “We would like to send our sincere condolences to the patient’s family and apologise for the delay and distress caused to the patient and his family.”

He said it had “carried out a comprehensive investigation of this incident which found that errors were made in the handling of the call that led to the call being categorised for a response within 20 minutes”.

They added: “We take our response to patients very seriously and as such will take on board the findings from the inquest and we will be addressing the issues raised by the family and the coroner.”

It would not release its report into the death “due to the patient confidential nature of the report”.

THE 999 CALLS

EMERGENCY calls reveal Mrs Gould’s increasing desperation as she waits for an ambulance to arrive and operators’ apologies for delays.

In the first call, the operator asks a series of medical questions and says:

“We’ll be there shortly for you.”

In the second call, Mrs Gould said she called “about half-an-hour ago”, adding: “His breathing’s getting worse.”

The recorded calls includes her asking him: “All right?” He replies: “No and she says: “I know, I know about the pain.”

The third call begins with her saying she called about an hour ago and her husband is “getting very distressed”

His congested breathing clearly audible, the operator says: “We are trying to get to you as quickly as we can. I do apologise for the delay.”

The operator says: “We’ve just been absolutely inundated tonight, unfortunately” and gives her a reference number.

In the fourth call, Mrs Gould says she has waited “over an hour” and the operator says: “We have had quite a busy time this past night”.

He says: “We haven’t forgotten about you and we are coming to you as quickly as we possibly can.” Like the first, third and fourth call he tells her to call back if his condition worsens.

When she makes the fifth call she says: “The ambulance has just arrived”.