Prevention of Future Deaths reports · 2013

Carol Ann Gibson

Regulation 28 report to prevent future deaths, reference 2013-0183, written 12 Oct 2013. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report12 Oct 2013
Reference2013-0183
DeceasedCarol Ann Gibson
CoronerNicholas Rheinberg
Coroner areaCheshire
CategoryCommunity health care and emergency services related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  NHS England 
2.  Castlefields Health Centre 

1 

CORONER 

I am Nicholas Leslie Rheinberg, senior coroner for the coroner area of Cheshire 

2 

CORONER’S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. 

3 

INVESTIGATION and INQUEST 

On 10th August 2012 I commenced an investigation into the death of Carol Ann Gibson 
aged 65. The investigation concluded at the end of the inquest on 8th August 2013. The 
conclusion of the inquest was that the deceased died as a result of an adverse reaction 
to the drug nitrofurantoin and that her death was due to misadventure. 

4 

CIRCUMSTANCES OF THE DEATH 

The deceased had a history of severe urinary tract infections with severe symptoms of 
both  a  physical  and  mental  nature.  In  2007  her  General  Practitioner 
  having 
taken  advice  from  a  consultant  prescribed  the  drug  nitrofurantoin  on  a  prophylactic 
basis.  The  deceased  subsequently  suffered  from  serious  lung  disease  as  an  adverse 
reaction  to  the  drug  and  when  in  2008  this  was  recognised  as  a  probability,  the 
prescription of the drug was discontinued and an alert was subsequently posted in the 
patient’s medical records. In 2011 the deceased again suffered a urinary tract infection. 
  failed  to  heed  the  alert  within  the  medical  records  and  on  10th  August  2011 
issued a further prescription for the drug 
issued a prescription for nitrofurantoin. 
on 12th April 2012 and on 26th July 2012 a nurse practitioner within the medical practice 
also  issued  a  prescription  for  the  drug.  On  1st  August  2012,  without  examining  the 
patient,  a  final  prescription  of  nitrofurantoin  was  issued.  On  8th  August  2012  the 
 Palacefields, Runcorn as a result of an 
deceased died at her home at 
adverse reaction to nitrofurantoin. 

5 

CORONER’S CONCERNS 

During the course of the inquest the evidence revealed matters giving rise to concern. In 
my opinion there is a risk that future deaths will occur unless action is taken. In the 
circumstances it is my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.   

1. 

ignored a warning alert in the medical records that his patient had 
suffered an adverse reaction to nitrofurantoin without checking the nature of the 
adverse reaction and issued a prescription for the drug regardless. 

2.  A letter dated 3rd November 2008 was sent by a consultant to 

 at 

Castlefields Health Centre identifying that the interstitial lung disease from which 

1

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3. 

 on commenting on alert warnings, said that most are “trivial, spurious, 

irrelevant or just wrong”, identified a phenomenon that he described as alert 
fatigue and further stated that colleagues within the practice had admitted that 
they “may well have done the same in my situation”. 

comments correctly describe the attitude within his 

I am concerned that if 
medical practice to patient safety alerts this is a matter of considerable concern and 
warrants investigation by you to ensure first of all that the practice has a robust system 
in place for posting such alerts, secondly that such alerts when posted, correctly and 
sufficiently identify the problem and thirdly that doctors and medical staff within the 
practice have full understanding and training to respond to such alerts in an appropriate 
manner. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you have the 
power to take such action.  

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 7th October 2013. I, the coroner, may extend the period. 

Your response must contain details of action taken or proposed to be taken, setting out 
the timetable for action. Otherwise you must explain why no action is proposed. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons namely the solicitors representing 
and the solicitors representing 

 the deceased’s daughter 

I am also under a duty to send the Chief Coroner a copy of your response.  

The Chief Coroner may publish either or both in a complete or redacted or summary 
form. He may send a copy of this report to any person who he believes may find it useful 
or of interest. You may make representations to me, the coroner, at the time of your 
response, about the release or the publication of your response by the Chief Coroner. 

9 

12th October 2013]                                               

2

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