An eight-year-old boy who died after three doctors missed signs of undiagnosed meningitis was 'completely failed' by hospital staff at an 'unsafe' children's unit, an inquest was told.
Logan Jones, from Magor, Monmouthshire, died on November 19, 2019, after he left the Royal Gwent Hospital in Newport, South Wales, without being seen by a doctor.
His mother Michelle Allen, who described Logan as a 'very happy child', took her son home before he was seen as she said the hospital was 'chaotic' and there was nowhere for her unwell son to lie down.
Just hours later at 3.50am, the youngster died at home, with his medical cause of death recorded as pneumococcal meningitis, despite three doctors missing signs of the illness, the inquest heard.
The eight-year-old was born with a heart defect and a genetic condition known as Chromosome 14, which meant he had learning difficulties and required feeding by tube.
A children's nurse told the inquest that the conditions at Royal Gwent Hospital's Child Assessment Unit were not 'safe' on the evening of November 18, when Logan was at the unit.
Senior coroner for Gwent, Caroline Saunders, said Logan was seeking care within a 'broken system' and that his mother's decision to take him home was the 'lesser of two evils'.
Ms Saunders said Logan was 'completely failed' by hospital staff but added that she couldn't determine whether his experience directly contributed to his death and therefore recorded a conclusion of natural causes.
Logan Jones (pictured), from Magor, Monmouthshire, died on November 19, 2019, after he left the Royal Gwent Hospital in Newport, South Wales, without being seen by a doctor
The inquest heard a statement from Logan's mother, Ms Allen, who said Logan loved Peppa Pig and also enjoyed day trips to Big Pit and Bristol Zoo.
The devastated mother said Logan was was 'surrounded by affection' at school, was very close to his sister and loved fashion and music.
In her statement, Ms Allen said Logan first started feeling unwell on November 15, 2019. She said he had a headache, felt lethargic and had vomited.
The next day, she called the out-of-hours service and said although Logan had perked up a little, the first responder advised her that she should still take him to A&E at Royal Gwent Hospital.
On arrival at around 11am, Logan was triaged and had his vital signs observed by triage nurses as well as by the ambulance crew.
Though everything appeared normal, the inquest heard how Logan should have been seen within one hour considering his complex medical history. He was eventually seen at 2pm.
Dr Alejandro Levin, a junior registrar with four months of paediatric experience, saw Logan at the hospital and he told the inquest that Logan was not showing any key symptoms of meningitis such as a stiff neck or obvious light sensitivity.
He said that 'no doctor wants to miss meningitis' but concluded at the time Logan's problems were 'most probably a viral illness'.
Dr Levin said he did not consult with a more senior colleague before discharging Logan as he 'did not think it was necessary'.
This decision was supported by consultant Edward Valentine in his evidence because '[Logan] had been there for three hours and his vital signs hadn't changed'.
His mother Michelle Allen took Logan home from Royal Gwent Hospital (pictured) before he was seen as she said the hospital was 'chaotic' and there was nowhere for him to lie down
Though Dr Levin said Ms Allen was offered to keep Logan in hospital for further observations she took him home and agreed to bring him back if his condition worsened, the inquest heard.
In her statement, Ms Allen said Logan seemed to perk up briefly, but he quickly went 'downhill' so she took him to see his GP, Dr Andrew Gray.
Appearing at the inquest, Dr Gray said on examining Logan he could not find a rash and that there was no evidence of a stiff neck.
He added: 'We have a traffic light system for meningitis and my assessment was that he didn't score very high on that at all. He was on the green, which is low risk.'
But Ms Allen remained concerned and Logan seemed unwell, he 'wasn't happy to send him home' so referred Logan to hospital.
When Ms Allen arrived at Royal Gwent Hospital, at what was then the Child Assessment Unit (CAU), at 6.02pm she described the scene as 'chaotic' and she knew she would be there 'for some time'.
Ms Allen said: 'I asked for a bed as Logan was wanting to lie down, which he could not do in the waiting room.
'[I was] told he could not, he would have to stay in the waiting area...as Logan was wanting to lie down and the department was chaotic.'
Ms Allen said
