Prevention of Future Deaths reports · 2014

Mone White

Regulation 28 report to prevent future deaths, reference 2014-0031, written 21 Jan 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Jan 2014
Reference2014-0031
DeceasedMone White
CoronerAndrew Walker
Coroner areaLondon (North)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedNorth West London Hospitals NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published2

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

i, _ North London c. Court,
Her Majesty’s Coroner for the 29 Wood Steet

Northern District of Greater London Barnet ENS 4BE
(Harrow, Brent, Barnet, Haringey and Enfield) Telephone 0208 447 7680

Fax 0208 447 7689

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:

i. Northwick Park Hospital
Watford Road,
Harrow,
Middlesex,
HA1 3UJ

2. Department of Health
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS

1 | CORONER

| am Andrew Walker, senior coroner, for the coroner area of Northern District of Greater
London

2 | CORONER’S LEGAL POWERS

| 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 the 12 July 2012 | opened an inquest touching the death of Mone Jahni Karl White,
aged 3 years old. The investigation concluded at the end of the inquest on the 17"
January 2014. The conclusion of the inquest was “Narrative verdict”, the medical case of
death was ;1a Acute heart failure, 1b Asthma/ chest infection, and under paragraph 2
Dilated cardiomyopathy.

4 | CIRCUMSTANCES OF THE DEATH

Mone suffered with dilated cardiomyopathy, probably caused by a viral infection. Mone
was under the care of the Royal Brompton hospital and had repeated episodes of illness
requiring hospital treatment precipitated by infections.

The Royal Brompton Hospital had in 2010 produces a document giving guidance to
those who may come into contact with Mone. A copy was sent to Northwick Park /
Hospital and the London Ambulance Service and Mone’s parents had a copy.

Mone was admitted on the 5"" July 2012 having been brought into Northwick Park
Hospital by ambulance with an episode of illness.

The doctors who treated Mone had not seen this document despite there being a copy
in the medical notes.

- Her Majesty's Coroner for the

a Northern District of Greater London
(Harrow, Brent, Barnet, Haringey and Enfield)

On the 7" July 2012 Mone’s condition was stable at the time of the ward round in the
morning but had deteriorated by 10.50. Doctors attended and began to treat Mone.

Shortly before 11.25 Mone became unresponsive and despite attempts it was not
possible to save his life.

lf Mone had been referred and been accepted by the Royal Brompton Hospital on the 5°
or the 6" July 2012 it is likely that he would not have died when he did.

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) The development of a flag system for patients, under the care of specialist

hospitals, with special clinical requirements to ensure that advice about clinical care
is brought to the attention of all treating clinicians.

6 | ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you
[AND/OR your organisation] 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 Friday 14" March 2014. |, 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

| have sent a copy of my report to the Chief Coroner and to the following Interested
Persons Representative of members of the family.

1 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 thp release or the publication of your response by the Chief Coroner.

9 | 21 Janyary 201

Responses

2 responses published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Respondent Not Named (PDF)
aR From the Rt Hon Jeremy Hunt MP

Secretary of State for Health

Department
of Health
Richmond House
79 Whitehall
Lond
POCI_838141 SWIA 2S
Tel: 020 7210 3000
Mr A Walker Mb-sofx@dh gsi.gov.uk

Senior Coroner

North London Coroners Court

29 Wood Street

Barnet

EN5 4BE -5 MAR 9nd

ex Am. Weller

Thank you for your letter following the inquest into the death of Mone Jahni Karl
White. In your report you conclude that the medical cause of death was acute heart
failure, asthma/chest infection and dilated cardiomyopathy.

Mone was a three year old boy who suffered with dilated cardiomyopathy and was
under the care of the Royal Brompton Hospital. He had repeated episodes of illness
requiring hospital treatment.

In 2010 the Royal Brompton Hospital produced a guidance document for those who
might come into contact with Mone and sent copies to Northwick Park Hospital, the
London Ambulance Service and Mone’s parents.

On 5 July 2012 Mone was taken ill and brought by ambulance to Northwick Park
Hospital. The doctors treating him did not see the guidance document despite there
being a copy in the medical notes.

On the 7 July 2012, Mone’s condition deteriorated and although doctors attended
and treated him he later became unresponsive and it was not possible to save his
life.

You comment that had Mone been referred to the Royal Brompton Hospital on the
5th or 6th July it is likely he would not have died when he did.

You also ask that we consider:

e The development of a flag system for patients, under the care of specialist
hospitals, with special clinical requirements to ensure that advice about

clinical care is brought to the attention of all treating clinicians.

I am very grateful that you have brought this important patient safety issue to my
attention.

It appears that there was already an effective system in place to ensure that
important information was sent to relevant organisations likely to come into contact
with Mone, but that this was not seen or acted upon by the clinicians treating Mone
at Northwick Park Hospital.

I note that you have sent a copy of this Regulation 28 report to the Northwick Park
Hospital. I anticipate that they will be able to comment in more detail on the reasons
why the doctors treating Mone had not seen the guidance document prepared by the
Royal Brompton Hospital and I would expect them to properly respond to the issues
concerning local care procedures and standards, which you have raised.

’ I can also advise that the General Medical Council (GMC) is the body responsible

for setting good medical practise standards for doctors.

Within the GMC code of practise, “Good Medical Practise” there is a section
covering the continuity and coordination of patient care which makes clear that all
relevant information should be shared with colleagues involved in a patient’s care.
I’ve quoted the relevant extract below for your information:

Continuity and coordination of care
44, You must contribute to the safe transfer of patients between healthcare
providers and between health and social care providers, This means you must:

a. share all relevant information with colleagues involved in your patients’ care
within and outside the team, including when you hand over care as you go off duty,
and when you delegate care or refer patients to other health or social care
providers

b. check, where practical, that a named clinician or team has taken over
responsibility when your role in providing a patient’s care has ended. This may be
particularly important for patients with impaired capacity or who are vulnerable
for other reasons.

45. When you do not provide your patients’ care yourself, for example when you are
off duty, or you delegate the care of a patient to a colleague, you must be satisfied
that the person providing care has the appropriate qualifications, skills and
experience to provide safe care for the patient.

With regard to developing a flag system in specialist hospitals to ensure that advice
about clinical care is brought to the attention of all treating clinicians, I consider that

aes

Department
of Health

this is a matter for attention at local, rather than national level. The NHS Trust
concerned needs to ensure they have a system in place whereby all relevant, and
available, information is routinely accessed and acted upon.

I would of course be happy to consider any national learning that may come about
as a result of this sad case.

I hope that this response is helpful and I am grateful to you for bringing the
circumstances of Mone’s death to my attention.

SOs, svawey

Sa
Pg
JEREMY HUNT
Response from 2 (PDF)
Peter’ Worthington, Chairman The North West London Hospitals [7i59

David McVittie, Chief Executive and na
Merger Transaction Director Tee

Tel: 020 8869 2005 Trust Headquarters
Fax: 020 8864 5511 Northwick Park Hospital
Email: nwlh-tr.trust@nhs.net Watford Road
Harrow

Middlesex

HA1 3UJ

15" April 2014

Mr Andrew Walker

Senior Coroner

North London-Coroners Court
29 Wood Street

Barnet

EN5 4BE

Dear Mr Walker
Re. Regulation 28 Report to Prevent Future Deaths

Further to the receipt of the above, | am able to confirm that The North West London
Hospitals NHS Trust (NWLHT) has developed a flagging system for patients under the
care of specialist hospitals with specialist clinical requirements. This will ensure the advice
about the clinical care of these children is brought to the attention of all treating. clinicians.

The flagging system has been devised in partnership with the Consultant Paediatricians
and the IT Department. The process has been documented and is supported by a
standard operating procedure which clearly defines the purpose, scope, duties,
responsibilities and process.

The need for and implementation of the flagging system has been discussed widely within
the Paediatric Directorate and was presented at our most recent Governance meeting.

| am able to confirm that the flagging system has been implemented and further work is
underway to improve its functionality.

| am happy to provide further detail should this be required.

Yours sincerely

CA ME

David McVittie
Chief Executive and Merger Transaction Director

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