Coroners have issued six Regulation 28 reports aimed at preventing future deaths after inquests involving ambulances having to queue outside North Wales hospitals.

But a call has been made for a simple conclusion of natural causes in the case of a woman suffering from sepsis who had to wait two hours before being admitted to the Maelor Hospital, Wrexham.

Samantha Brousas died on February 23, 2018, less than 48 hours after arriving outside the emergency department and an inquest in Ruthin has heard how paramedics and her daughter Sophie, a medical student, suspected she had sepsis.

Miss Brousas, 49, of Bron y Groes, Gresford, had been suffering from a cough since January but her condition deteriorated over a few days. She had difficulty breathing, had a high temperature and was vomiting, with diarrhoea. On February 20 her GP diagnosed it as gastro-enteritis.

Professor Solomon Almond, an independent expert called in by the coroner to study the case, said that Miss Brousas survived so long because she was so fit, but was so ill that she was “destined to die” by the time she reached hospital.

To have more than a 50/50 chance of survival she would have had to be admitted before noon on the 21st.

In fact, the ambulance was not called until later that afternoon and with the emergency department under extreme pressure was kept waiting.

On the fourth day of the hearing Dr Kate Clark, a consultant in emergency medicine, and Duncan Robertson, consultant paramedic with the Welsh Ambulance Services Trust, outlined the numerous steps taken to tackle the problem and improve the flow of patients through the hospital.

As a result there has been a tenfold reduction in the hours lost by ambulances outside the Maelor Hospital.

Among the failings identified in the wake of Miss Brousas’ death were that the paramedics should have pre-alerted the hospital on their journey - that is now the policy for all sepsis patients – and the triage system for patients kept in ambulances has been tightened.

Questioned by solicitor Stephen Jones, representing the Brousas family and her partner Simon Goacher, Dr Clark confirmed that two Regulation 28 reports had been issued by coroners following incidents in 2018 and a total of six.

Mr Jones said a narrative conclusion would be most appropriate in order to explain the full circumstances of her death.

“The tragedy in this case is that Sam’s condition was recognised and yet nothing was done, and that means there were failings within the system,” he said.

But barrister Dan Rogers, for the Betsi Cadwaladr University Health Board and Ambulance Trust, stressed that Professor Almond’s evidence was important.

He told Joanne Lees, assistant coroner for North Wales East and Central: “Any failings or criticism you may find are not clearly and directly causal in her death.”

Mrs Lees said she needed more time to consider the evidence before reaching a conclusion, and the hearing was adjourned until December 20.