A 13-year-old girl with a severe dairy allergy may have been served with hot chocolate that was made with cows’ milk after a possible “miscommunication” of the order, an inquest has heard.
Hannah Jacobs, who had been allergic to dairy products, along with fish and eggs, since she was a toddler, died within hours of taking one sip of the drink on February 8 2023, East London Coroner’s Court was told.
Urmi Akter took the order for the takeaway drinks from Hannah’s mother Abimbola Duyile, who has previously told the hearing her “anger gave way to terror” after her child’s reaction to the drink.
Ms Akter used her legal right, under coroners’ rules, not to answer a series of questions that could be seen as incriminating as she gave evidence at the inquest on Tuesday. They related to her training, understanding, knowledge and actions as she was being given the order.
The court has heard Hannah suffered an “immediate reaction” after just one sip of the takeaway drink that her mother bought before attending a dentist appointment at 11am. Hannah was declared dead by 1pm that day.
A post-mortem examination found Hannah died after suffering from a hypersensitve anaphylactic reaction triggered by an ingredient in her hot chocolate that caused an allergic response.
The inquest has heard there is a factual dispute about the order and Ms Duyile says she asked for two soya hot chocolates and asked staff to thoroughly clean the equipment.
Ms Akter, who had worked at the Costa Coffee franchise in Barking for about eight months, told the court she could hear and see Ms Duyile “clearly” as she served her at the counter.
In her statement to the inquest, Ms Akter had said Ms Duyile asked for two hot chocolates adding: “Can you wash the jug because my daughter has a dairy allergy?”
Under Costa’s rules, customers who ask for a non-dairy product or state they have a dietary requirement should be shown a book that is kept under the till which includes ingredients and details of how the drink is made, the court heard.
Ms Akter’s statement added: “I did not show the mother the book as she told me washing the jug was fine. I thought she, as the mother, would know more about (it).
“I gave her the drink she requested.”
Ms Akter told the court she had repeated Ms Duyile’s request that the jug be washed and also pointed out that hot chocolate is made from milk.
She said Ms Duyile replied “that’s fine”.
Assistant coroner Dr Shirley Radcliffe, who had told Ms Akter she did not have to answer certain questions if she felt “it may incriminate you”, said: “As far as I understand you said the mother mentioned the dairy allergy. The book was not shown to the mother and only thing done was to make one drink, wash the jug and make the other drink.”
The coroner had also asked Ms Akter why she had not shown an allergy book to Ms Duyile which is in line with her training and if she thought it was “strange” that the mother was asking you to wash out the jug between making the two drinks.
Ms Akter, who sat beside a Bengali interpreter as she gave evidence, declined to answer.
Emily Slocombe, representing Hannah’s family, asked: “If you had got out the allergy book and shown and discussed this with Hannah’s mother, this would have been an opportunity for any miscommunications to be cleared up, wouldn’t it?”
Ms Slocombe also asked Ms Akter if she repeated the order back to Ms Duyile.
Other questions included whether Ms Akter was given training in her own language, if refresher training had been provided, if she knew what an allergen was, and also if she knew the potential consequences of being subject to any allergy.
She was also asked if anyone checked her understanding of the training and if she ever wrote anything on a drink to identify what is in it.
Another question related to whether she was ever told about using different jugs for different drinks.
She was also shown a document which said a “product nutrition and allergy guide must be referred to every time” and if she was aware of this.
Ms Slocombe also asked why Ms Akter did not confirm whether cows’ milk was being used after she had been told of Hannah’s dietary needs and if she had told the barista who went on to make the drink about the allergy.
She did not give an answer to the questions.
Ms Duyile previously told the court Hannah sipped the drink when she was at the dentist and “abruptly got up and went to the toilet and shouted ‘that was not soya milk’.”
Hannah was said to be coughing up phlegm.
Ms Duyile then rushed Hannah, who was complaining of chest pains, to a nearby chemist as her “lips and mouth were very swollen and she was itchy”.
Hannah collapsed in the chemist and the pharmacist gave her an EpiPen injection in her leg. Attempts to resuscitate were started and a customer called an ambulance. Paramedics soon arrived and continued resuscitation efforts before Hannah was taken to hospital and died.
Dentist Iqra Farhad said nurses offered Ms Duyile an EpiPen with 300mg of adrenaline, which the inquest has heard could have helped save Hannah’s life.
Ms Duyile instead left to go to a chemist and get an antihistamine called Cetirizine.
Ms Farhad, who saw Hannah only briefly, said: “When I spoke to the patient she said she was fine,” while Ms Duyile tried to arrange a new appointment during the time Hannah had gone to the toilet.
Ms Farhad said “there was no sign of panicking or distress”.
She also said the team at the dentist surgery had emergency training which included how to administer adrenaline.
The court heard standing up while having an allergic reaction could be detrimental and there would have been a need to lie the child down.
The inquest also heard there is a general shortage of EpiPens and that Zeenat Panirwala, the customer in the chemist who tried to resuscitate Hannah, also had allergies and had an EpiPen.
Pharmacist Santokh Kahlon said he would “definitely” have used the extra EpiPen if he had known there was one.
He told staff to look around to see if there were any EpiPens but none could be found.
Ms Panirwala said Ms Duyile was “struggling” to come to terms with what was happening as she saw Hannah in distress.
She said Ms Duyile blamed Costa Coffee for giving her child the drink.
“The mother was hysterical saying ‘she’s dead, she’s dead’,” Ms Panirwala said.
