Mother and daughter found dead months after 999 call ‘missed opportunity'
A inquest into the deaths, expected to last for five days, began on Monday with assistant coroner Amanda Bewley hearing that Ms Leuga called 999 three months before her body was found, telling a call hander she was cold and could not move.
The hearing was told that during the call, made shortly after 1pm on February 2 last year, Ms Leuga groaned, requested an ambulance and said 'I need help to my daughter' and 'I'm in the bed, I feel cold and can't move' before cutting off the line.
Police at the scene in May last year (Jacob King/PA)
She also gave details of her address in Hartley Road, Radford, Nottingham, where her body and that of her daughter were found on May 21 last year.
Giving evidence to the inquest, East Midlands Ambulance Service's head of patient safety, Susan Jevons said the call handler, an emergency medical adviser, should have referred the call to the control room despatch officers.
Ms Jevons said attempts had been made to call Ms Leuga back, but she told the inquest: 'The call should have been left for an ambulance to attend once we had got the address, which we had.
'The ambulance didn't go to the address because the emergency medical adviser, thinking it was an abandoned call, closed the call down.
'So it wasn't visible to anybody within the emergency operations centre.'
The coroner told Ms Jevons she would have to consider the possibility that sending an ambulance to the address 'might have been the difference between life or death' for Loraine.
The inquest was told that Ms Leuga was admitted to hospital for a blood transfusion in late January last year as she was critically ill with very low iron levels, and was given a 'pragmatic' discharge linked to her daughter's care needs.
The coroner asked Ms Jevons whether, if she found at the end of the inquest that Loraine had died after her mother, there had been a 'missed opportunity' in relation to the teenager's death.
Ms Jevons responded: 'Yes, there was a missed opportunity for an ambulance to attend Alphonsine when she requested one.'
The mother and daughter's home after their bodies were found (Jacob King/PA)
Earlier, pathologist Dr Stuart Hamilton told the hearing by video-link that the mother and daughter were both likely to have been dead for 'weeks to months' before they were found, rather than for days or hours.
Dr Hamilton said his initial cause of death following a post-mortem examination on Ms Leuga was pneumonia of uncertain cause, while her daughter's cause of death could not be established.
Answering questions from the coroner, the pathologist said he could not rule out that Ms Leuga had died on the day of the 999 call.
The body of Loraine, who the inquest was told was 'entirely dependent on her mother to meet her hydration and nutritional needs', showed no evidence of any third party involvement.
Dr Hamilton said of the teenager: 'Unfortunately, based on the post-mortem examination and additional tests alone, it is my view that the cause of death is classed as unascertained – that is, I am not able to give a cause of death on the balance of probabilities.'
Asked to comment on the possibility that Loraine's death may have been because of dehydration or malnutrition, Dr Hamilton answered: 'There is nothing in my findings that say any of that is incorrect.'
Loraine was more likely to have died from dehydration than malnutrition, the witness said, if it was accepted that she 'wasn't able to make the decision to drink water' because of her difficulties.
The inquest continues.
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Alphonsine Leuga, 47, and her daughter Loraine Choulla, 18, were found dead inside their home in Nottingham, on May 21, 2024. A mum who was found dead alongside her teenage daughter had pleaded for an ambulance, telling emergency call handlers she was freezing and couldn't move. However, help never came. Alphonsine Leuga, 47, and her daughter Loraine Choulla, 18, were found dead inside their council home on Hartley Road in Radford, Nottingham, on May 21, 2024. The inquest heard the pair likely died "weeks to months" before they were discovered, reports the Mirror. Alphonsine's provisional cause of death has been established as pneumonia of uncertain cause, while her daughter's cause of death remains unascertained. An inquest into their deaths started on Monday, July 21, at Nottingham Coroners' Court. The first day of the hearing was told of a missed opportunity from East Midlands Ambulance Service (EMAS) to send an ambulance to their address. The hearing was told that the mother had been admitted to City Hospital between January 26 and 28, during which she was "critically unwell". Coroner Amanda Bewley was told that Alphonsine had low iron levels, required a three-litre blood transfusion, and was suffering from a respiratory tract infection during a hospital stay in January. But she was discharged "pragmatically" on January 28 as she was the sole carer for her daughter, who was 'entirely dependent' on her. Loraine had Down Syndrome and learning disabilities. Just a week later, on February 2, Alphonsine made a 999 call at 1.04pm, pleading for help. Join the Daily Record WhatsApp community! Get the latest news sent straight to your messages by joining our WhatsApp community today. You'll receive daily updates on breaking news as well as the top headlines across Scotland. No one will be able to see who is signed up and no one can send messages except the Daily Record team. All you have to do is click here if you're on mobile, select 'Join Community' and you're in! If you're on a desktop, simply scan the QR code above with your phone and click 'Join Community'. We also treat our community members to special offers, promotions, and adverts from us and our partners. If you don't like our community, you can check out any time you like. To leave our community click on the name at the top of your screen and choose 'exit group'. If you're curious, you can read our Privacy Notice. A transcript of the call was read to the court. Alphonsine said: "I need some help please. I need help to my daughter. I feel cold. I am on the bed. I feel cold and can't move. Please send an ambulance. I do not want police, I need ambulance… my daughter. Would you send an ambulance? Please, come, please." The court heard mumbling and groaning in the background, and Alphonsine was repeatedly asked what language she spoke and where she lived, despite stating her address clearly multiple times. Susan Jevons, head of patient safety at East Midlands Ambulance Service (EMAS), confirmed Ms Leuga gave her address clearly. But the call was cut off and although attempts were made to ring her back, no contact was made. The inquest heard EMAS should have categorised the emergency as a Category 3 call, which requires a crew to arrive within 120 minutes. However, an ambulance was never dispatched because emergency medical advisor wrongly closed the call down, assuming it had been abandoned. Ms Jevons explained. She said: "That should not have happened because we had obtained the address and a disposition from Alphonsine. "They followed the abandoned call process when they shouldn't have because they had an address and phone number [for Ms Leuga]. The abandoned call process should only be used for hoax calls. We should not have followed this process at all. "EMAS did contact Alphonsine back to get more information but the call remained unanswered and the call was marked as abandoned which should not have happened." Ms Jevons told coroner Ms Bewley that there was a missed opportunity from the emergency medical advisor to seek guidance from a senior colleague regarding how to proceed with the call after no contact could be made with Ms Leuga. Had that happened, the call would have remained active and an ambulance would likely have been dispatched. She admitted: "There was a missed opportunity for an ambulance to attend Alphonsine's address." The hearing also heard that if an ambulance had been sent, it could have "made the difference between life and death for Loraine." Since the incident, EMAS staff have been told to re-read the protocol on handling abandoned calls. The inquest was told there have been no similar incidents since February 2024. Pathologist Dr Stuart Hamilton said it could not be ruled out that Alphonsine died the very same day she made the 999 call. He said "significant post-mortem change" had hindered the findings, but an internal examination showed inflammation in the lungs, consistent with pneumonia. Dr Hamilton told the court it was "impossible" to pinpoint when either woman died, but said Alphonsine had likely been dead for weeks to months. The same was concluded for Loraine. The the Mirror. heard she was totally reliant on her mother for food and water. While she could fill a glass if prompted, she wouldn't do so unassisted. The teenager's stomach was empty at the time of the post-mortem. Her weight had plummeted from 108kg in February 2023 to 59kg in May 2024. While some of that drop could be attributed to post-mortem change, Dr Hamilton said: "There is nothing in my findings suggesting that dehydration as a cause of death would be incorrect. Dehydration causes death more rapidly than malnutrition." A cause of death was proposed by coroner Ms Bewley as 1a dehydration and 1b Down Syndrome and learning disabilities. This will be officially established at the end of the coronial proceedings, however, on Friday, July 25. The inquest continues.
