Mr Hamza suffered a heart attack and died on 7 December 2011. Earlier that day he had attended Somerton Road Medical Clinic (SRMC) complaining of chest pain and was told that it was likely musculoskeletal.
During the three-four days before his death, Mr Hamza experienced intermittent chest pain. On the day of his death that pain was central, stabbing and extended to his neck and arm. Mr Hamza’s wife called SRMC and was advised to bring him to the clinic. At SRMC, Mr Hamza explained his pain to a nurse and she performed an electrocardiogram (ECG) on him, the results of which were normal.
Mr Hamza then saw Dr Audish who had been his doctor since 2011. The doctor observed the ECG results and advised Mr Hamza that he was likely suffering muscular pain. The doctor ordered various non-urgent tests not relating to his heart. Mr Hamza left SRMC assured that his pain was not serious.
Later that day Mr Hamza was found unconscious in his backyard and by the time the paramedics attended he was already deceased.
The Coroner’s inquest focused on two central issues:
- whether Mr Hamza’s wife should have been advised to call an ambulance when she called SRMC; and
- was the doctor’s assessment and treatment of Mr Hamza appropriate.
Given that Mr Hamza’s wife advised SRMC of his chest pain over the phone, the Coroner found that the appropriate triage response was either to put the call through to a doctor or nurse, or to advise her to call 000.
As to the assessment and treatment of Mr Hamza, an expert panel considered that whilst one normal ECG with a clinical evaluation may be enough to rule out cardiac cause for a patient’s chest pain, such is inappropriate where there are other classic symptoms of cardiac pain.
In Mr Hamza’s case, pain radiating to the neck, arm or jaw was considered a classic symptom of cardiac pain and should have been assumed to have been cardiac in nature. Mr Hamza’s three-four day history of intermittent chest pain was likely to be unstable angina, and the change he experienced in the nature of his chest pain indicated an evolving process and should have been cause for concern.
Importantly, the expert panel advised that if cardiac pain could not be conclusively excluded, the appropriate treatment would have been to immediately refer Mr Hamza to hospital by ambulance.
The doctor’s assessment and treatment of Mr Hamza was lacking in that she either incorrectly ruled out a cardiac cause for his chest pains or, not having ruled out the cardiac cause, she failed to appreciate the urgency of the matter. The Coroner concluded that it was unfortunate that the doctor was unable to demonstrate appropriate professional reflection in Mr Hamza’s case.
Based on the inquest into Mr Hamza’s death, the Coroner recommended that general practitioners:
- implement protocols to give effect to the Heart Foundation’s Action Plan so that any patient calling a general practice with chest pain matching the description in the Action Plan be advised to call an ambulance and/or be immediately referred to an emergency department;
- undergo training in relation to the significance of the absence of pain and a normal ECG in determining whether a person is suffering an acute coronary episode; and
- appreciate the importance of comprehensive clinical notes.
The Coroner’s recommendations are a timely reminder to general practitioners that any patient presenting with chest pain needs to be assessed as soon as possible, whether over the telephone or in person with urgent referral to an emergency department being the priority.