The twin sister of a woman who died under a coat in a crowded Nottingham A&E says her story shows “the whole hospital system isn’t working” as she fears more people could die due to overcrowding and mistakes. Inga Rublite, 39, died after being found unconscious on the floor under a coat more than eight hours after arriving at A&E at Queens Medical Centre in Nottingham on 19 January. Her name had been called by hospital staff three times, but when Rublite failed to respond, they assumed she had left and discharged her from the system. She was found slumped on the floor by staff arriving on duty at 7am. She had suffered a brain haemorrhage, with an inquest concluding in July that she died of natural causes and would probably still have died from a “catastrophic bleed” even if she had been treated quicker. Her twin sister, Inese Briede, said her family does not agree with this inquest’s findings, and believe there is no way of knowing for sure whether Rublite would have died if she had been seen by a doctor earlier. “The inquest said she died of natural causes. Yes, I understand that an aneurysm is a natural cause, but the way she waited and the way she was treated there … No, I still see that as negligence,” she said. “I believe that each person and body is different, and you can’t be 100% sure that she would have died anyway.” At the inquest, Dr John Walsh, the deputy medical director at Nottingham university hospitals NHS trust, outlined a number of steps being taken to ensure a similar situation doesn’t happen again. These included moving chairs in the waiting room to ensure they are always in the sight of staff, increasing the numbers of doctors on duty and implementing a stricter procedure for following up on patients who don’t respond to their name being called. Briede said: “Any change the hospital makes for patients is a good change, but I just don’t see that it’s enough. The hospital needs to look over everything, it’s not just a few steps that need to be taken.” She said she was shocked at how accustomed staff had become to overcrowded conditions, and the fact that it was happening in hospitals around the country. “The whole hospital system isn’t working properly. And they need to figure it out because problems with the system, these mistakes, are still causing what they already caused with Inga,” she said. “But I do have sympathy for the staff. It’s because of overcrowding, that’s not how you’re supposed to treat a patient.” The inquest heard there were 61 patients in the A&E waiting area the night Rublite arrived, significantly more than the 38 considered maximum capacity, and doctors had been diverted elsewhere in the hospital to deal with patients being off-loaded from a queue of ambulances. There was no senior doctor available to make a decision about Rublite’s treatment when she arrived, and this was cited as a key reason why a CT scan, which would have detected the bleed on her brain, was not requested. Briede said one of the most upsetting parts of the inquest came when staff said Rublite may have been mistaken for a homeless person, who often comes into the A&E waiting room to sleep under their coats in winter, and this might explain why she was missed. “Hearing that was a big shock. I was thinking, she never looked like a homeless person. And even if a homeless person goes in, they need to be treated too,” Briede said. “I know that English is not my first language, and at some points I was listening to the inquest and I thought, did I really understand that correctly?” She said Rublite’s family, who live in Latvia, are still struggling to come to terms with her death, as are her two sons, aged 13 and 11, who live with their father in England. “The family still can’t believe that she’s gone. Because it was so sudden and every time we talk about Inga we just say that she was supposed to be saved, and they could have saved her,” Briede said. “We can’t believe you can sit at the hospital and nobody does anything for you.” Dr Manjeet Shehmar, medical director at Nottingham university hospitals NHS trust said: “We would like to offer our sincere condolences to the family of Inga for their loss. Although due to the nature of the bleed on the brain the outcome is unlikely to have been different, we accept there were missed opportunities in Inga’s care and are truly sorry that we did not meet the standards we strive to deliver. “We have completed an investigation in order to assess and implement learning, and as a result have introduced changes in our emergency department to ensure we can deliver better care to patients and support our staff to do this in the future.”