Over a span of days, Joshua England’s pleas for help became more desperate.
“I’ve been puking all night, and now I’m puking what looks like blood,” he wrote to his medical providers on May 22, 2018. “My stomach hurts so, so bad.” At the medical clinic that day he clutched his abdomen and described his pain as sharp and intense — an 8 out of 10. But he was seen by a lesser-trained licensed practical nurse, who didn’t give him a complete abdominal exam or send him for any lab work. Instead he was given Pepto-Bismol and told to drink water and eat fibrous food.
The Pepto-Bismol didn’t help. The next day England wrote that his pain was so bad he could barely breathe. He couldn’t eat or sleep. He again went to the clinic, where he said he’d had bloody stool and his pain was now a 10 out of 10. The physician assistant found that his pulse was racing but didn’t conduct an abdominal exam. Instead, he chalked up England’s symptoms to constipation and prescribed a laxative.