Pupil who died on school trip to New York was treatable right up to cardiac arrest, inquest hears

A teenager who died on a school trip to New York was treatable right up to the point of her cardiac arrest on the morning of her death, a doctor told an inquest today.

Ana Uglow, 17, had felt unwell for a week before she collapsed in her hotel room during an American history trip.

But the teen, who was a sixth form pupil at Bristol Grammar School, told her family her concerns were not being taken seriously as she struggled to breathe during a tour of the Empire State Building.

She died at Mount Sinai West hospital after collapsing with blood coming from her nose and mouth and suffering a cardiac arrest.

A report by the chief medical examiner of the city of New York concluded that Ana, of Redland, Bristol, had died from Bronchopneumonia and sepsis complicating an influenza upper respiratory infection, the inquest heard.

Dr Chris Danbury, a consultant in intensive care medicine, said he’s dealt with numerous 16 and 17-year-olds over his career.

He told the court he believed Ana would have most likely had an infection on December 17, 2019, that she ‘probably had sepsis’ on December 18 and was then in septic shock waking up on December 19.

He believes it was the septic shock that then caused Ana to suffer a cardiac arrest and die that day.

The court heard Ana had been in cardiac arrest for nine minutes before paramedics arrived to assess her.

Ana Uglow, 17, a student at Bristol Grammar School, was seen 'retching' over a bin in the Empire State Building on the day before she was pronounced dead at Mount Sinai West hospital in December 2019

Ana Uglow, 17, a student at Bristol Grammar School, was seen 'retching' over a bin in the Empire State Building on the day before she was pronounced dead at Mount Sinai West hospital in December 2019

Ana Uglow, 17, a student at Bristol Grammar School, was seen ‘retching’ over a bin in the Empire State Building on the day before she was pronounced dead at Mount Sinai West hospital in December 2019

‘She was very treatable right up to the point where she had a cardiac arrest,’ Dr Danbury told the court.

‘Nine minutes of cardiac arrest due to septic shock is a very very long time. Time is absolutely of the essence when you get to that sort of situation.’

Dr Danbury added that antibiotics would have ‘slowed the progression’ of Ana’s condition if taken days before her death.

‘It’s just the sheer factor of receiving antibiotics that would have made the difference,’ he said.

‘If she had taken oral antibiotics just before she went to bed on the 18th, she would have probably woken up on the 19th feeling really rough but not in the physiologically extreme state that she was in when she actually woke up.’

Dr Danbury said many teenagers would have wanted to keep up with the group rather than seeing a doctor, but Ana showed signs of regressing as her condition worsened on December 17.

‘Prior to that she’d been feeling unwell, but she’d been keeping up with everything that was going on,’ he said.

‘My reading of the records is this was the first date when she actually said she was having difficulty keeping up with the rest of the party and for the first time she acknowledged she may have a chest infection.

Her parents David and Natalia (pictured) told the inquest Ana told teachers she thought she had chest infection and asked to see a doctor two days before her death, but this was 'refused'

Her parents David and Natalia (pictured) told the inquest Ana told teachers she thought she had chest infection and asked to see a doctor two days before her death, but this was 'refused'

Her parents David and Natalia (pictured) told the inquest Ana told teachers she thought she had chest infection and asked to see a doctor two days before her death, but this was ‘refused’

‘They (teenagers) want to keep up with their peers at all costs. It’s very unusual for them to suddenly bail out or apparently bail out of a trip like this to America to spend some time seeing a doctor rather than doing whatever else their friends are doing.’

The court heard yesterday from teacher Rory Hambly that on the train journey to New York via Philadelphia, Ana had enquired about the ‘situation’ regarding getting a doctor if she was feeling worse later that day.

Dr Danbury said: ‘I accept that there are different ways of reading the statement, but when I wrote my report, I was reading certainly one teacher not wanting or not feeling that it was appropriate to take Ana to a doctor at that point.’

He also admitted to the court that a person such as Ana would show ‘peaks and troughs’.

On Ana’s health during the trip, he said: ‘There will be times when she feels better and time when she feels worse. But the overall trend is one of getting worse.’ 

Her parents have already claimed at an inquest in Bristol that teachers were more interested in seeing the sights than getting her help.

Her mother Natalia Uglow told the coroner her daughter felt her teachers were too focused on enjoying visits to historic landmarks across the US than on dealing with her developing illness.

The coroner heard the group arrived in America on December 14 and were led by Ellice Clare and Rory Hambly.

Ana Uglow (pictured), 17, a student at Bristol Grammar School, was pronounced dead at Mount Sinai West hospital in December 2019

Ana Uglow (pictured), 17, a student at Bristol Grammar School, was pronounced dead at Mount Sinai West hospital in December 2019

Ana Uglow (pictured), 17, a student at Bristol Grammar School, was pronounced dead at Mount Sinai West hospital in December 2019

Ana Uglow (pictured), 17, a student at Bristol Grammar School, was pronounced dead at Mount Sinai West hospital in December 2019

Ana Uglow (pictured), 17, a Bristol Grammar School student, was pronounced dead in December 2019 after complaining of an illness on a school trip to New York, an inquest heard

An inquest into Ana's death is taking place at Avon Coroners Court and will last five days

An inquest into Ana's death is taking place at Avon Coroners Court and will last five days

An inquest into Ana’s death is taking place at Avon Coroners Court and will last five days

What are the key symptoms of sepsis? The ‘silent killer’ that can cause death in minutes

Sepsis, known as the ‘silent killer’, strikes when an infection such as blood poisoning sparks a violent immune response in which the body attacks its own organs.

It is the leading cause of avoidable death, killing at least 44,000 a year.

If caught early, the infection can be controlled by antibiotics before the body goes into overdrive – ultimately leading to death within a matter of minutes.

But the early symptoms of sepsis can be easily confused with more mild conditions, meaning it can be difficult to diagnose.

A patient can rapidly deteriorate if sepsis is missed early on, so quick diagnosis and treatment is vital – yet this rarely happens. 

In the early stages, sepsis can be mistaken for a chest infection, flu or upset stomach. 

The six signs of something potentially deadly can be identified by the acronym ‘SEPSIS’:

  • Slurred speech or confusion.
  • Extreme shivering or muscle pain.
  • Passing no urine in a day.
  • Severe breathlessness.
  • ‘I feel like I might die.’
  • Skin that’s mottled or discoloured.

Anyone who develops any of these symptoms should seek medical help urgently — and ask doctors: ‘Could this be sepsis?’

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They spent a number of days seeing the sights in Washington before catching a train to New York on the December 17 – stopping for the day in Philadelphia on the way. 

The inquest previously heard that Ana’s parents David and Natalia said she told teachers she thought she had a chest infection and asked to see a doctor two days before her death, but this was ‘refused’.

Mrs Uglow said she rang the trip’s emergency phone number before texting it: ‘Why did you not take Ana to the doctor when she asked???’

She told the inquest at Avon Coroner’s Court: ‘I was very furious with those teachers who neglected Ana’s request to see a doctor on Tuesday morning and after she had been sick overnight, nothing was done to save her life.’ 

However, a teacher told the inquest yesterday that Ana had only complained of feeling tired and having a blocked nose, and did not directly ask to see a doctor. 

The inquest, due to last for five days, heard Ana collapsed in her hotel room on the morning of December 19 and was pronounced dead after arriving at the hospital.

A report by the chief medical examiner of the city of New York concluded that Ana, of Redland, Bristol, had died from Bronchopneumonia and sepsis complicating an influenza upper respiratory infection.

In a statement read to the inquest, Ana’s mother Natalia Uglow described how she was a ‘conscientious’ student who was very active in the school and was a senior prefect.

Ana had been off school with a cold-like symptoms for two days before the trip but felt better and set off to Washington from Bristol early on December 14.

The following day, Ana told her mother that she was ‘exhausted’ and had done a walking tour of Washington with fellow students and teachers Rory Hambly and Ellice Clare.

On December 16, Ana ‘described that she had no energy to walk’ and had asked to stay at the hotel while the group went to the National Museum of African American History and Culture.

Coroner's Court heard Ana was on a school trip in New York. Pictured: Bristol Grammar School

Coroner's Court heard Ana was on a school trip in New York. Pictured: Bristol Grammar School

Coroner’s Court heard Ana was on a school trip in New York. Pictured: Bristol Grammar School

They travelled by train from Washington to Philadelphia on December 17 and Ana called her mother several times during the journey.

‘Ana said that she was worried she had a chest infection, that she felt much worse and had a fever and a cough,’ Mrs Uglow said.

‘She said that the teachers had really annoyed her as she was out of breath and exhausted and could not keep up with their walking but that they just ignored her and carried on.

‘She said that they were ‘real history fanatics and all they cared about is chasing those sites and were very excited about them’.

‘I was concerned about her and said to Ana to speak to the teachers and ask them to see a doctor and phone me back.

‘I told her to exaggerate her symptoms if necessary to get the result and say that her parents were concerned.

‘I also offered to speak to them myself. I believe Ana spoke to Mr Hambly as she reported back that Mr Hambly had told her that she would have had a higher temperature if she had a chest infection and advised her to take paracetamol.

‘I was also told he had also suggested that they go to a pharmacist in Philadelphia to get some stronger drugs and that if she felt worse in New York they would take her to a doctor.’

Later that day, Ana sent her mother a text message to say she was feeling ‘a bit better’.

Mrs Uglow told the inquest: ‘She was concerned, she was worried and to my dying day I will never forgive myself for not following through my request for her to see a doctor and not phoning the teachers myself and putting pressure on them.’

She said her daughter ‘respected’ both Mr Hambly and Ms Clare and would not have wanted to ‘nag’ them.

A report by the chief medical examiner concluded that Ana had died at Mount Sinai Hospital from Bronchopneumonia and sepsis complicating an influenza upper respiratory infection

A report by the chief medical examiner concluded that Ana had died at Mount Sinai Hospital from Bronchopneumonia and sepsis complicating an influenza upper respiratory infection

A report by the chief medical examiner concluded that Ana had died at Mount Sinai Hospital from Bronchopneumonia and sepsis complicating an influenza upper respiratory infection

On December 18, Ana told her mother she had not slept as she was sick and had asked the teachers if she could stay in her hotel room that day but they had ‘forced her to go on a walking tour as they could not leave her alone’.

The following day, Dr Uglow received a phone call from the school’s headteacher stating that Ana was in a critical condition in hospital.

Mrs Uglow said she rang the trip’s emergency phone number before texting it: ‘Why did you not take Ana to the doctor when she asked???’ 

Dr Uglow described receiving a phone call from the headteacher informing him that Ana was in hospital.

‘I told the headmaster that the teachers had been treating Ana terribly,’ Dr Uglow said.

Giving evidence, Mr Hambly said Ana complained of feeling tired and having a blocked nose in the days before her death.

On the train journey, she asked ‘about if she was feeling worse in New York what would the situation be about getting to a doctor’ but did not directly ask to see one, he said.

Mr Hambly insisted he had told Ana they could see a doctor if that was the case and suggested she take paracetamol, after which she appeared ‘much brighter’.

He later advised her to buy decongestant and cough syrup from a pharmacy in New York.

On December 18, Ana came on the walking tour before shopping with a friend but that evening she had a ‘coughing fit’ and ‘lent over a bin and retched’ during a tour of the Empire State Building, he said.

Mr Hambly was awoken by Ana knocking on his door complaining of feeling unwell, her heart racing and a sore back at about 6.30am on December 19.

He said Ana was walking and talking ‘normally’ and returned to her hotel room but about an hour later, her friend came and said she was unwell.

‘Not even in my wildest dreams could I have imagined what the next few minutes were going to bring,’ Mr Hambly said.

Ana collapsed in the room shortly after Mr Hambly arrived. He called the emergency services and she was taken to hospital, where she was pronounced dead at 10am.

The inquest continues.

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