UPDATE: A family is demanding accountability after a shocking inquest revealed that delays in ambulance response contributed to the tragic death of 62-year-old Peter Coates. The grandfather, who suffered from Chronic Obstructive Pulmonary Disease (COPD), died on March 14, 2019, while waiting for emergency medical assistance that took over an hour to arrive.
At an inquest held at Teesside Magistrates Court, Kellie Coates, Peter’s daughter, expressed her anguish, stating that memories of her father’s final moments, gasping for breath and waiting helplessly, now “haunt” her family. The distressing revelation that an ambulance, just minutes away, was delayed by operational failures has intensified their grief.
Mr. Coates called 999 at 4:01 AM, requesting urgent help when a power-cut disrupted his oxygen supply. Despite being classified as a category 2 emergency, which mandates a response within 18 minutes, the ambulance crew faced a series of obstacles. An initial crew was unable to leave the station due to malfunctioning electronic gates, while a second crew, dispatched from Coulby Newham, arrived only at approximately 4:43 AM.
During the inquest, a harrowing 999 call was played, where Mr. Coates urgently told the operator, “you better get someone quick.” Tragically, by the time paramedics gained access to his home, he had already succumbed, despite his efforts to reach backup oxygen cylinders.
Expert testimony during the hearing indicated that the lack of oxygen was a decisive factor in Mr. Coates’ death. Dr. Simon Quantrill, a medical expert, stated, “Oxygen is the key factor,” confirming that even a brief absence of oxygen could have been fatal for Mr. Coates. His statement highlighted the critical timing: “He made the call at 4:01 AM, and within the next 45 minutes or so, he had died.”
Kellie Coates revealed the family’s shock upon learning years later about the ambulance service’s operational failures through media reports. She stated, “We were told they got to him as quickly as they could. It was only three years later that we found out this wasn’t the case.” This revelation has added to their pain, as they firmly believe that had the ambulance arrived on time, her father could have survived.
The inquest also uncovered troubling insights into the North East Ambulance Service’s practices, with whistleblower Paul Calvert previously highlighting discrepancies in reporting and operational procedures. The ambulance service has acknowledged historical failings in its processes, and a review led by Dame Marianne Griffiths pointed to “leadership dysfunction” as a contributing factor in this tragic case.
As the inquest continues, with further testimony anticipated from North East Ambulance Service personnel, the Coates family remains resolute in seeking justice for Peter. They hope this case will prompt urgent changes to ensure such delays do not endanger lives in the future.
This tragic incident has not only revealed critical issues within emergency response protocols but has also underscored the urgent need for reforms to prevent similar heartbreak for other families. The inquest is set to conclude on January 8, and the community is watching closely as new evidence emerges.
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