NHS 111 told North London woman with ‘red flag’ vomiting to stay home – she died from brain damage

NHS England is reviewing its triage training for call handlers after 53-year-old Mulu Yohanes suffered a seizure and cardiac arrest days after being discharged from hospital

A coroner has issued a warning over NHS triage systems after the death of a North London woman from complications following surgery.

Muluembet ‘Mulu’ Yohanes, 53, died in February 2025 from complications from minimally invasive brain surgery she underwent weeks before. An inquest into her death concluded that she died from a combination of pneumonia following a stroke and seizure, brought on by low sodium levels following the operation to remove a non-cancerous brain tumour.

Ms Yohanes began experiencing intermittent vomiting three days after she was discharged from University College London Hospital (UCLH) in Camden in January 2025. Clinical staff had advised her upon discharge that this symptom would be a “red flag” and any vomiting would need urgent medical attention.

The next day, after her son called 111, he was advised that she treat the symptoms at home. He placed another call the following day and was told that if she continued vomiting she should come to A&E.

Two hours later that morning she was found unresponsive, and by the time paramedics arrived she was in cardiac arrest.

Ms Yohanes was resuscitated, but after being taken to hospital doctors found her sodium levels were critically low and the loss of oxygen to the brain had given her “irreversible” brain damage. She died on February 25.

Assistant Coroner, Melanie Lee, said it was likely Ms Yohanes had suffered a seizure but it was impossible to say if, had the complications had been flagged earlier, her death could have been avoided. But the coroner has since written to NHS England warning that potential flaws within the health service’s 111 service could put lives at risk.

The coroner noted that the person handling Ms Yohanes’s emergency call incorrectly recorded her surgery as “head injury”, and warned that she had not been asked if she had been given “discharge, worsening or red flag advice” by the surgery team at UCLH.

“Had they done so, this may have prompted Mulu to review the written discharge advice she had been given,” the coroner concluded.

The London Ambulance Service told the coroner it had recommended that NHS Pathways, the clinical support system used by the health service, includes prompts for neurosurgery under the category of “head injury” or “vomiting”. This prompted the coroner to advise that NHS Pathways should indeed include neurosurgery, rather than leave it for call handlers to choose the most “appropriate pathway”.

However NHS England declined to make this change. While expressing deep condolences for Ms Yohanes’s death, the health body said its triage tool was “not diagnostic” and only worked by ruling out more serious causes of symptoms.

The health service explained that NHS Pathways deliberately does not reference specific conditions because there are already questions to identify symptoms that “indicate onward need for care”, such as confusion, drowsiness and abnormal responses. The health body added that all health advisors using the triage system have to complete training for using the call line, including guidance on what to do in the case of recent hospital discharge.

However, the NHS agreed with the coroner that her vomiting should not have been assessed as resulting from a “head injury”. In light of Ms Yohanes’ case, the NHS is reviewing the training for one of its pathways to make sure call handlers consider if callers have been given post-op instructions.

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