Prevention of Future Deaths reports · 2014

Stephen Ellis

Regulation 28 report to prevent future deaths, reference 2014-0102, written 5 Mar 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report5 Mar 2014
Reference2014-0102
DeceasedStephen Ellis
CoronerJohn Pollard
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths
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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: Secretary of State for Health.

1 | CORONER

| am John Pollard, senior coroner, for the coroner area of South Manchester

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 13" November 2013 | commenced an investigation into the death of Stephen
Ellis dob 23™ December 1953. The investigation concluded on the 4"" March 2014
and the conclusion was Misadventure. The medical cause of death was 1a
Haemopericardium 1b Recent aortic root graft and aortic valve replacement
surgery and subsequent warfarinisation 1¢ Aortic stenosis and aortic root
aneurysm 2 Ischaemic and hypertensive heart disease, long term haemo-dialysis
due to previous nephrectomies for renal cell carcinoma.

4 | CIRCUMSTANCES OF THE DEATH: The deceased was admitted to hospital for the
necessary heart surgery and he was acknowledged to be a patient with significant
co-morbidities. After the surgery he was administered warfarin and thereafter
there appears to have been some blood oozing from around the grafted area.
When he was administered the warfarin whilst in hospital his INR levels were
carefully monitored but upon his release from hospital these checks were reduced
to ‘weekly’ and it is apparent that his INR was rising without this being properly
noted at the time. The consultant surgeon who performed the operation told me in
evidence that warfarin home monitoring kits are readily available and widely used
outside the UK. If Mr Ellis had had such a monitoring kit, he may have registered a
higher than acceptable INR and this may have been picked up. If so, it was the
view of the surgeon, the outcome might have been different and he could have
survived.

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. — | believe it would be good practice
to supply warfarin home management kits to ‘high risk’ patients who have
undergone heart surgery and are subsequently warfarinised. The cost of such kits
would probably equate to, or be less than, the cost of hospital monitoring.

6__| ACTION SHOULD BE TAKEN

T

In my opinion action should be taken to prevent future deaths and | believe you have
the power to take such action. It is essential that full information is passed promptly to
the GP practice of a patient being discharged.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report, ,
namely by 1° May 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.

COPIES and PUBLICATION

| have sent a copy of my report to the Chief Coroner and to the followi
Persons Fy oon of the deceased),
(surgeon), the Coroners Society of England and Wales. | have also sent it to the

Chief Executive Central Manchester Foundation NHS Trust who may find it useful or
of interest. ;

|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 repr tations to me, the coroner, at the time of your
response, about the release or thé publication of your response by the Chief Coroner.

91

‘John Pollard, HM Senior Coroner

14™ January 2014

[—

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