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According to the coroner, the occasion was the first time the rule had been imposed in regard to an emergency appointment, and Clark was reportedly told to come back in the morning without the doctor even looking at her daughter's medical records.
"From the evidence before me, it is not possible for me to determine with certainty whether an earlier intervention would have altered the outcome for Ellie, but nonetheless Ellie should have been seen by a [doctor] that day, and she was let down by the failures in the system," the coroner wrote, according to ITV.
Grange Clinic released a statement in response, saying, "Dr. Rowe knows that nothing can be said to Ellie-May's family to make a difference, but she would like to say how truly sorry she is."
The Clark family responded by acknowledging the apology and by expressing disappointment “that a finding of neglect was not reached,” saying in a statement via their lawyer, “The family acknowledge an apology from Dr. Rowe, especially as they have been waiting in excess of three years for an outcome and to receive answers to their questions.”
The coroner will now write a report to the clinic and local health board aimed at addressing the incident and preventing similar tragedies in the future. In the meantime, a spokesman for Aneurin Bevan University Health Board said it would be "inappropriate to comment whilst we await the coroner's report."