Nursery worker died after contracting hepatitis and Covid during lockdown

A nursery worker died after developing acute autoimmune hepatitis and Covid-19 while waiting for a liver transplant, an inquest heard.

Katie Horne, 21, died on April 11 2020, just over a month after she first visited the Princess Royal Hospital in West Sussex with jaundice, dark urine, tiredness and cramps.

She was later transferred to King's College Hospital in London with the aim of having a liver transplant, but tested positive for Covid-19, meaning she was prevented from receiving a transplant due to the medical guidance in place at the time.

Senior Coroner Andrew Harris, who drew a short-form conclusion of natural causes, said the combination of liver failure, the effect of the Covid-19 pandemic on hospitals and Ms Horne contracting Covid-19 led to her death.

He said there was "no evidence" that either hospital had provided inappropriate care to Ms Horne, but raised concerns about the delay in receiving results and involving a gastroenterologist in her care.

During an inquest at Inner London South Coroner's Court on Wednesday, the court heard that Ms Horne, who had a history of autoimmune illnesses in her family, faced a delay in receiving her blood test results determining what type of hepatitis she had due to a "backlog" at the lab as a result of the pandemic.

Consultant Tatyana Viner, who saw Ms Horne two days after she first presented at hospital with symptoms on March 1, told the inquest there were no gastroenterologists available on site when she first visited the hospital.

Questioned if Ms Viner chased the lab results when Ms Horne saw her on March 3, she said she presumed a junior doctor would have done so.

Asked why she didn't, she replied: "I was busy."

Ms Horne returned to hospital a further two times before receiving her results, and then met with gastroenterologist Dr Nick Parnell on March 16, 15 days after she first went to hospital.

Questioned by the coroner as to why the gastroenterologist was not approached after he said there would have been one on site, Dr Parnell said: "I do not know why their advice was not sought."

He described Ms Horne's condition, which was later confirmed to be acute autoimmune hepatitis resulting in acute liver failure, as "rare" and "aggressive".

On March 18, Ms Horne was admitted to the Princess Royal as an inpatient and began receiving steroid treatment on March 20.

The inquest heard that if Dr Parnell was involved earlier, she could have started being treated 10 days earlier than she did.

Ms Horne was later transferred to King's College Hospital, in London, on March 24 and was placed under the care of Dr Varuna Aluvihare.

But she tested positive for Covid-19 four days later - which was contracted prior to her admission to King's - meaning she was no longer eligible for a transplant.

Ms Horne was then moved to intensive care on April 5 after "deteriorating quickly" and died on April 11.

Both Dr Parnell and Dr Aluvihare agreed that if she had received treatment sooner it would have had a "better outcome", but they were unable to say if she would have survived.

Mr Harris said he would provide a prevention of future deaths report as the Princess Royal had not undertaken an internal investigation following Miss Horne's death.

He told the inquest: "The trust has not made any attempt to find any evidence over the last two years as to why there was a delay with the results and her meeting a gastroenterologist. This is not very reassuring for the family."

He added: "None of us could move into the shoes of the family and think what it is like to lose a child at the beginning of her life. It is unthinkable.

"Nothing will be able to mend their lives from this devastating loss."

Following the verdict, Tony Horne, her father, told the PA news agency: "It's taken two years and four months to get here. Katie was just starting her life, she was 21 years old.

"She just started a new job, she was loving her position. The nursery loved her, the kids loved her. That's been taken away. That hurts the most for us.

"We always felt there were things missed. We just want people to learn the lessons so that nobody else is in this position again."