A man was left lying on the ground unaided for nearly 40 minutes after he fell outside the entrance to a hospital casualty unit.

Stephen Marsden, 56, of no fixed address, suffered a fractured skull after losing his balance as he walked out of Bradford Royal Infirmary's accident and emergency department.

An inquest jury at the Bradford hearing yesterday watched dramatic video footage which showed how Mr Marsden was left lying on the ground by medical staff who were unaware he was injured.

The jury was told that Mr Marsden, an alcoholic, was taken into police custody but his condition worsened and he died in hospital two days later.

Coroner Roger Whittaker said it was believed Mr Marsden had sustained a fatal injury in the fall, on Sunday, July 29, 2001.

He added: "This injury was not appreciated at the time and he remained, to all intents and purposes, flat on his back outside the A&E door in the sight of medical, security and ambulance personnel until the police arrived to take him away without further medical intervention."

Mr Whittaker said Mr Marsden was put in a "drunks cell" at Lawcroft House police station, where he was regularly visited. He was later found unconscious and taken by ambulance back to BRI, where the fractured skull was discovered.

He was transferred to the neuro-surgery department at Leeds General Infirmary where he had an emergency operation but it was agreed to withdraw life support, after discussions with his family, and he died on July 31.

The inquest heard Mr Marsden had been found slumped at the side of Saltaire Road, Shipley, on the Sunday afternoon and taken by ambulance to BRI after telling the crew he had fallen and cut his cheek.

The video, taken from security cameras around the entrance to the A&E unit, showed Mr Marsden being brought into casualty in a wheelchair at 5.45pm.

Seven minutes later he is seen leaving, after deciding not to wait for treatment, but returns minutes later with another ambulance crew after he was found lying on the ground near the hospital. He is placed in a wheelchair and sits by the exit door until getting up, at the second attempt, and going outside. He is then seen to fall over backwards, at 6.11pm, and lays prostrate on the ground.

Hospital staff and paramedics are seen walking past him or standing over him until two police officers arrive at 6.50pm, pick him up and take him to a police van.

Pathologist Dr Kenneth Shorrock said Mr Marsden, who had worked as a coalman and a building site labourer before developing drink problems, had suffered a fractured skull.

Dr Shorrock said he believed the fall outside the hospital had caused his death. There had been irreversible changes to the brain due to lack of oxygen which can be caused by the brain swelling and breathing difficulties.

Hospital staff said Mr Marsden regularly attended the hospital with minor injuries after having falls after drinking.

A&E senior sister Barbara Clark, who was on duty at the time, said that on the Sunday Mr Marsden had caused a nuisance by annoying other patients.

She was then told he was lying in the access road outside and causing an obstruction and had to be brought inside.

She gave instructions for the police to be called to remove him if he was a further nuisance, but shortly after 6.30pm she was told he was on the floor outside again.

Sister Clark told the inquest: "I had no idea he had fallen. No-one had told me. If I had been made aware I would have gone out, assessed him, got him in a wheelchair and brought him in. I wouldn't have left him lying as he was."

The hearing was continuing today.