A 'bright' teenager tragically died after a phobia of needles caused her to decline vital blood tests that could have led to a leukaemia diagnosis.
Abby Holgate, from Newark, had been suffering with an acute tooth abscess and was prescribed antibiotics, but continued to feel unwell.
She was offered blood tests, which may have detected the more serious underlying condition, but she refused them.
Sadly, by the time the McDonald's employee went ahead with the blood work and canulation for septic shock, it was too late for doctors to save her.
The coroner who heard the cause highlighted a few issues in the teen's care, however accepted that there were "significant barriers" to securing immediate blood tests and early recognition of leukaemia, Nottinghamshire Live reports.
Abby, 17, was admitted to intensive care at King's Mill Hospital, Mansfield Road, Sutton-in-Ashfield, and had a heart attack 12 hours after admission on March 17, 2021.
At the Nottingham Council House inquest into her death, Dr Elizabeth Didcock, assistant coroner for Nottingham, concluded her death was due to natural causes.
Abby had acute lymphoblastic leukaemia - a highly aggressive blood cancer - which saw only 800 cases this year in the country.
It was likely it had been present for a few weeks or a couple of months but treatment was available.
Two potential symptoms of leukaemia are unresolved infection - Abby's tooth was still causing her problems - and anaemia.
Her devastated family - Noreen Holgate, who is Abby's grandmother, Abby's mum Angela Holgate, aunt Ashley Smith, and uncle Eric Holgate - paid tribute to her afterwards.
Noreen said she hoped things would change medically so it did not happen to anyone else.
And she described her granddaughter, who was studying health and social care at Magnus Church of England Academy, Newark, as "like a shooting star".
"She crossed our lives burning so bright but, like a shooting star, it was over way too soon."
Angela said her daughter was "full of life" and "always on the go".
Abby was found to have the abscess on February 25, 2021, and a badly-decayed lower left tooth was the cause.
But in the days that followed, she continued to experience pain and the need for a blood test was discussed but she declined.
Dr Didcock found the doctor should have communicated the discussion with Abby on her discharge letter and asked her GP to arrange a blood test for her.
This test would have shown low Hemoglobin and evidence of anaemia and "it was an opportunity missed by her GP".
But the coroner also acknowledged the teenager had a "needle phobia", and "I don't know if she would have attended for it (the blood test)".
When East Midlands Ambulance Service were called about her tooth ache, she refused a needle or canular.
While the coroner found it was likely Abby saw a doctor at hospital, his assessment was not recorded.
The teenager's observations were stable at that time and she went home without a blood test being completed or a follow-up arranged.
This was "another missed opportunity", said Dr Didcock, to try to achieve a blood test for now clear presentation of anaemia and unresolved infection.
By the time she went back to her GP, she was told she needed to go to hospital.
When she returned, she continued to refuse bloods being taken or a canular inserted, despite efforts to persuade her with a painkiller and numbing cream.
The coroner found there was an "appropriate capacity assessment" by the hospital. Abby was becoming increasingly distressed. The staff did not have the grounds to restrain her to take her blood.
She ended up in hospital again needing critical care. She accepted blood tests and canulation but it was too late.
A pathologist ruled she was more prone to sepsis because of leukaemia, and that she died of natural causes likely because of her dental issue.
Sherwood Forest Hospitals NHS Foundation Trust's serious incident investigation had been full and thorough, said Dr Didcock, and led to important actions and better understanding of a patient's consent and capacity.
"I don't think different actions would have made a difference for Abby, but it is important for other young people who attend in a similar situation."
A spokesperson for Sherwood Forest Hospitals said: "We would like to express our sympathy and condolences to Abby's family. Following this tragic case, a full review has been carried out and lessons have been learned about how we could do more to support people like Abby and her family in future."
