Retired nurse, 58, died in agony after NHS Direct refused to send ambulance because the 'computer said no' Gillian Given, 58, called 999 suffering severe abdominal pain in July 2012 Put through to NHS Direct nurse who decided she didn't need ambulance She died in agony two hours later - post mortem examination revealed she had severe heart disease Gillian Given, 58, died in July 2012 two hours after an NHS Direct nurse told her that she did not need an ambulance A retired nurse died in agony two hours after NHS Direct decided that she didn't need to go to hospital by ambulance. After listening to a recording of the telephone call in which 58-year-old Gillian Given could be heard howling with stomach pain, John Gittins, the Coroner for North Wales Central, ruled that neglect played a part in her death. After the inquest her husband, retired licensee James Given, said he was considering whether to take legal action against the Welsh ambulance service over its handling of the case. During the hearing it emerged that Deborah Evans, the NHS Direct nurse who carried out the assessment for the ambulance service, had resigned shortly after the tragedy, which was the subject of an internal investigation. Mrs Given, who had suffered from arthritis for some years, died at her home in Lon y Dryw, Belgrano, near Abergele, on July 16, 2012, having been taken ill only that morning. She vomited and went to bed complaining of severe abdominal pains, which got worse during the day. Mr Given called their GP practice, the Gwrych Medical Centre and spoke to a receptionist who said that a doctor would visit later that afternoon. Shortly afterwards she told Mr Given to call 999, which he did. He was put through to Deborah Evans, based in the NHS Direct call centre at Swansea, and she went through a series of questions. She felt that an ambulance was not needed as Mrs Given's main concern was abdominal pains, and she urged her to take painkillers until the GP arrived. Mrs Evans told Mr Given: "I appreciate she is in pain but she doesn't need an ambulance." The surgery then confirmed that Dr Jon Evans would visit, but two hours later Mrs Given died. A post-mortem examination revealed that she had a severe heart disease. The British Heart Foundation told MailOnline that patients with severe heart failure can develop a build-up of fluid in the abdomen, and that this could have been the cause of Mrs Given's pain. Mrs Evans told the inquest that the actions taken depended on the patient's response. A post mortem examination revealed that she was suffering from severe heart disease. Her husband, James Given, is deciding whether to take legal action against the Welsh ambulance service Asked by the coroner: "When you eventually reach an outcome it is the computer which decides whether you send an ambulance or not?" She replied: "Yes." But she said there had been occasions when she had not agreed with the computer's findings. "You just feel that the patient is serious or something else is going on there," she said. The coroner commented: "Having listened to the telephone call Mrs Given appears to have been in an incredible amount of pain." Asked whether she had felt any "gut instinct" that an ambulance should have been called, Mrs Evans replied: "Yes." Stephanie Kneath, a manager with NHS Direct who conducted an inquiry into the incident after Mr Given complained, said it appeared that not enough questions had been asked of Mrs Given about the length of time she had been in pain and exactly where the pain was. John Gittins, the Coroner for North Wales Central, ruled that neglect played a part in her death "It needed to be more clear and I would have expected a member of staff to ask more questions," she said. If Mrs Evans had remained in the job she would have received further training and issues arising from the case had been acted upon, she told the hearing. Asked by the coroner whether there was any leeway for the nurses to deviate from the computer programme, she replied: "The system is to support their clinical knowledge." Both Mrs Evans and Mrs Kneath said that the call centre could be rather noisy at times which could lead to nurses not hearing responses correctly. Recording a verdict of death from natural causes, Mr Gittins said he did not believe there had been a systemic failure, but a failure to establish the proper route to take - in other words human error - amounted to neglect which contributed to Mrs Given's death. A Welsh Ambulance Service spokesperson said: 'Firstly, we wish to extend our deepest sympathies to the family at this difficult time. Whilst we make every effort to ensure the noise is kept to a minimum in our clinical contact centres, which includes providing large, divided work spaces and individual headsets that block background noise, we will review our arrangements in light of the inquest to ensure everything is done that can be within the environment of a busy clinical contact centre.