Prevention of Future Deaths reports · 2014

Maureen Leaver

Regulation 28 report to prevent future deaths, reference 2014-0036, written 27 Feb 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report27 Feb 2014
Reference2014-0036
DeceasedMaureen Leaver
CoronerKaren Henderson
Coroner areaWest Sussex
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedSussex Partnership NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

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.

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

1. Chief executive, Sussex Partnership NHS Foundation Trust

CORONER

lam Karen HENDERSON, assistant coroner for the coroner area of West Sussex

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

INVESTIGATION and INQUEST

On 18" November 2013 | commenced an investigation into the death of Maureen Leaver, 83 years of
age. The investigation concluded at the end of the inquest on the 25" November 2013. The medical
cause of death given was:

1a. Bronchopneumonia
1b. Hypothermia
1c. Risperidone toxicity and sepsis

Il. Dementia, Type 2 Diabetes Mellitus, polypharmacy, Stage 3 chronic kidney disease, congestive
cardiac failure (likely secondary to hypertensive heart disease)

2.
My narrative conclusion was:

Mrs Leaver suffered distressing delusions and hallucinations on a background of cognitive
decline, which required an emergency admission for her own protection on 24" July 2010.

During admission she was not fully assessed, investigated or given a formal diagnosis by a
senior responsible clinician. She was prescribed risperidone. The dose was increased for
uncertain reasons from 2 to 2.5 mg per day on 15" September 2010. The prescribing and
monitoring of risperidone did not adhere to national or published local guidelines.

Signs and symptoms of risperidone toxicity first became apparent on the 24'" September 2010 but
were not recognised as such. A chest infection was thought to be ‘brewing’ at the same time. No
physical measurements were taken until 26" September 2010.

Mrs Leaver was transferred to St Richard’s hospital for emergency treatment of profound
hypothermia on 26" September 2010. She was placed on the Liverpool Care Pathway on the 28"
September and died on 6" October 2010.

The safeguards in place at the time were inadequate to prevent this unfortunate chain of events
from occurring.

CIRCUMSTANCES OF THE DEATH

Mrs Leaver was admitted into the Harold Kidd Unit under Section 4 NHA on 24" July 2010 for
assessment, investigation and management of her severe delusions and paranoid thoughts and co-
existent dementia which made her incapable of living safely at home. She remained in the Harold Kidd
Unit until an emergency transfer to St Richard’s hospital, Chichester on the 26" September 2010 for the
management of profound hypothermia. During her time in the Harold Kidd Unit, there were little formal
investigation, diagnosis or management plan put in place with regard to her care. The underlying causes
of her hypothermia were considered to be Risperidone, which was increased for uncertain reasons along

with cold ambient temperatures on the ward and incipient chest sepsis. There was a delay in the
recognition of the severity of her signs and symptoms. She did not improve after correction of her
hypothermia at St Richards Hospital and was, within 24 hours of admission placed on the Liverpool Care
Pathway. She died on 6" October 2010.

CORONER’S CONCERNS

During the course of the inquest the evidence revealed matters giving rise for concern. In my opinion
there is a risk that future death 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 lack of medical supervision of in-patients in Grove Ward, Harold Kidd Unit and the lack of
effective systems to investigate, diagnose and manage acutely ill elderly patients suffering from
complex psychosis and associated dementia

2. A lack of understanding of the legal duties imposed by the Mental Health Act 1983 and the
Mental capacity Act 2005 when transferring patients who cannot consent to treatment from
Section 4 MHA 1983 to being an informal patient.

ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and | believe you and your organisation:

Sussex Partnership NHS Foundation Trust

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report, namely by 24"
March 2014. |, the coroner, may extend this 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.

COPIES and PUBLICATION

| have sent a copy of my report to the Chief Coroner and to the following Interested Persons (
Matron Grove Ward) and to the local safeguarding board.

| 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.

DATE: 27" January 2014 SIGNED: Karen Henderson Assistant Coroner

pe GER Uo eof.

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