Pathologist Misunderstood Man’s Death Outside McDonald’s: A pathologist who was involved in the inquiry into the death of Stephen Matthew Jones has issued an apology for a mistake that occurred during that investigation.
A Pathologist Got It Wrong About Why a Man Died Outside of McDonald’s
A pathologist who “misread” a man’s postmortem data has apologized. Stephen Matthew Jones, from Penley, Wrexham, was found slumped in the city center on December 14, hours after leaving the hospital. The inquiry into Mr. Jones’ death was postponed until 2021 due to his family’s fears.
Dr. Mark Atkinson decided Mr. Jones’ death was alcohol poisoning owing to elevated blood alcohol levels. On November 15, 2022, he informed the hearing he had committed a “mistake.”
Dr. Atkinson determined Mr. Jones’ cause of death based on his urine-alcohol level. Although high, it wasn’t “fatal.” Dr. Atkinson analyzed the information after Mr. Jones’ mother worried about a familial cardiac issue. One of Mr. Jones’ cardiac veins was clogged “almost to the point of abrupt death.”
Dr. Atkinson testified via video link: “I’m sorry for my error-filled report. I misread my colleague’s report and mistook pee for BAC.” Dr. Atkinson claimed Mr. Jones’ blood-alcohol level was 210 mg/100ml, not 341mg/100ml, which is not “fatal.” Dr. Atkinson said the amount was too low to cause death directly.
“He probably died from a cardiac issue, but drinking was more than a minor influence.” Dr. Atkinson reported Mr. Jones’ blood artery was 70-75% clogged.
Dr. Atkinson said Mr. Jones likely had the disease for years. Often undiagnosed. “People wander around with far worse instances for years without difficulties, but too much heart strain can be fatal.” Mr. Jones visited A&E three times in the 24 hours before his death, but each time he released himself. The inquest heard Mr. Jones was confused and “heavily drunk” before his death.
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Mr. Jones was found lifeless outside KFC in Wrexham around 2 p.m. Dr. Robin Roop said Mr. Jones’ awareness had worsened and he was given water and vitamins via a drip. Mr. Jones was discharged on December 13 after testing, including cardiac monitoring, which came back normal. At 7.30 pm, he returned via ambulance and was hospitalized for closer observation.
Inquest staff: Mr. Jones was closely monitored in the hospital ward, but it was “extremely busy” so the senior ward nurse didn’t see him. A&E sister Sarah Atkinson told the panel, “The department was quite busy, but if the nurses had had concerns about Stephen, they would have escalated them to me.”
Stephen left the hospital hours before his death, around 1 am. Ms. Atkinson said they couldn’t have done more to keep Mr. Jones in the hospital since he wanted to go. Paramedics found Mr. Jones unconscious in Regent Street, Wrexham, at 5.30 am and pronounced him dead shortly after. Since Mr. Jones’ death, Betsi Cadwaladr University Health Board has changed A&E protocols across North Wales.
These adjustments include missing persons and capacity measures to protect patients’ safety when they leave the unit. David Lewis, assistant coroner for North Wales east and central ruled that Mr. Jones died of natural causes, but alcohol contributed to his timing.
The hearing was placed in Ruthin County Hall. His mother, Susan Lee, stated, “As parents, we’ll always attempt to break things down, but at least we have the conclusion now.”
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