A 22-year-old man who died from sepsis did not receive the antibiotics and fluids “with the urgency that he should have”, a coroner has said.

William Hewes died within 24 hours of being admitted to Homerton University Hospital in east London after his meningitis, caused by a meningococcal infection, developed into sepsis in January 2023.

There were delays in giving him potentially life-saving treatment due to communication errors between staff, Mary Hassell, senior coroner for north London, said.

Delivering a narrative verdict, she criticised the hospital but added that “I simply do not know” if earlier treatment would have saved Mr Hewes.

His mother, Deborah Burns – who worked as a consultant at the same hospital – said she had asked staff on eight separate occasions if they had given him antibiotics.

“I wasn’t clock-watching but I knew they were not given straight away,” she said.

“I thought the nurse was prioritising other things, medication to treat his symptoms. It wasn’t medication that was going to change the outcome of what he had.”

Giving evidence during the inquest, the medical staff who treated him said they did not recall Dr Burns asking for antibiotics eight times.

Coroner Mary Hassell said she accepted Dr Burns’ evidence on this point, although she accepted hospital staff were not being deliberately untruthful but had not heard an instruction from the registrar to administer antibiotics and fluids, as well as medication for his symptoms.

She added that Mr Hewes did not receive the antibiotics and fluids “with the urgency that he should have”.

Nevertheless, she concluded, the 22-year-old was already very unwell when he arrived at the hospital and it was not clear if he had been treated quicker, he would have survived.

Following her son’s death, Dr Burns, a specialist in paediatrics, was told that Homerton University Hospital – rated as outstanding by inspectors – was going to investigate the death.

But months later she learned they had decided against an inquiry, as “there were no delays, there weren’t any concerns about his treatment”.

She told the BBC she “couldn’t understand why no investigation had been done… and also why I hadn’t been informed of the outcome”.

Dr Burns said she had been unable to return to work, as she had planned, due to the way she says the hospital had treated her family since her son’s death.

“I am now much more aware of the deeply ingrained, defensive culture within the NHS. I trusted them. I felt betrayed,” she said.

“It has been totally unnecessary. If it can happen to me, then I really worry for the general population,” she added.

Homerton University Hospital has been contacted for comment.