On December 14, 2022, nine-year-old Dylan Cope of Rhiwderin, Newport, died from septic shock following a ruptured appendix. His death came eight days after he was discharged from A&E at Grange University Hospital with a diagnosis of flu, despite concerns raised by his GP about suspected appendicitis.

Dylan’s parents had taken him to the hospital after his GP referred him for possible appendicitis. However, a paediatric nurse practitioner, Sam Hayden, assessed Dylan and concluded his abdominal pain was due to influenza A. The nurse practitioner, who was later identified as not being a doctor but an advanced nurse practitioner, did not conduct a documented physical examination by a senior doctor before discharging Dylan in the early hours of December 7.

During an inquest held in May 2024, the senior coroner for Gwent, Caroline Saunders, identified a “gross failure of basic care” by hospital staff. She found that had a senior doctor examined Dylan, he likely would have been admitted for further investigation and treated surgically before developing sepsis, and his death could have been prevented.

The coroner noted a critical breakdown in communication between Ms. Hayden and the senior registrar on duty, Dr. Lianne Doherty. The two clinicians offered conflicting accounts of their discussion; Ms. Hayden insisted she had mentioned concerns about abdominal pain, while Dr. Doherty recalled being told only about flu and no suspicion of appendicitis. As a result, Dylan went home without the required senior review.

Dylan’s father, Laurence Cope, repeatedly questioned staff about the accuracy of the flu diagnosis throughout the night, expressing concern that his son might have appendicitis. Despite his efforts, staff maintained the flu diagnosis and discharged Dylan with a leaflet for coughs and colds.

Following discharge, Dylan’s condition worsened. On December 10, after repeated attempts to contact medical advice lines, his father took him back to hospital. Emergency teams admitted Dylan, and he was transferred to intensive care in Cardiff. Surgeons confirmed his appendix had ruptured, leading to widespread infection. Despite intensive treatment, he died a week later.

During the investigation, it was revealed that Ms. Hayden had not reviewed the GP referral warning of suspected appendicitis prior to assessment, an omission the coroner described as “below an acceptable standard of care.” Ms. Hayden herself acknowledged it “wouldn’t be unusual” to assess children without reading referral documents, a practice the Cope family found deeply troubling.

In response to their loss, Dylan’s parents are advocating for policy changes to ensure that any child referred to A&E by a GP with a suspected serious illness receives a documented face-to-face examination by a senior doctor before being discharged. Corinne Cope emphasised the need to prioritise children’s safety and prevent similar tragedies.

The Aneurin Bevan University Health Board, which operates Grange University Hospital, has acknowledged its responsibility and apologised for the failings in Dylan’s care. The board stated it has implemented significant improvements.

The Welsh Government and the UK Department of Health and Social Care both emphasised that children should be reviewed by clinicians with appropriate seniority and expertise before discharge. However, neither committed to enshrining the parents’ specific recommendation into policy.

The case has highlighted growing concerns about reliance on advanced nurse practitioners in A&E settings, with Freedom of Information data showing increased use of such practitioners in place of doctors despite official guidance that they should not replace medical staff.