Prevention of Future Deaths reports · 2014

Ronald Perry

Regulation 28 report to prevent future deaths, reference 2014-0302, written 2 Jul 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report2 Jul 2014
Reference2014-0302
DeceasedRonald Perry
CoronerJohn Gittins
Coroner areaNorth Wales (East & Central)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

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 (1)

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

BCUHB, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW

1 | CORONER

| am JOHN ADRIAN GITTINS, senior coroner, for the coroner area of North Wales (East
and Central)]

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 21 of January 2014 | commenced an investigation into the death of Ronald
Perry (DOB 22.11.1955 DOD 18.01.2014). The investigation concluded at the end of
the inquest on the 19" of June 2014 and | recorded a conclusion of Natural Causes with
the cause of death being 1(a) Ruptured Atheromatous Aortic Aneurysm

4 | CIRCUMSTANCES OF THE DEATH

The Circumstances of the death are that the Deceased had attended at Glan Clwyd
Hospital, Bodelwyddan on the 17"” of January 2014 and that following examination at
their Emergency Department was discharged home. Several hours later he collapsed,
was readmitted but could not be resuscitated.

5 | CORONER’S CONCERNS

During the course of the inquest, evidence given » iii
BED i cicatcd that had the Deceased undergone a CT scan then it is probable
that his aneurysm would have been detected and that he would have undergone
surgery. However different criteria exist within BCUHB by which CT scans can be
requested by clinicians dependent upon the time of day (before or after 5.00 pm) or
whether such a request is made at a weekend.

The MATTERS OF CONCERN are as follows :-

That unless steps are taken to provide consistency within the levels of care provided to
patients on a 24 hour basis then there will be continuing risks to patients “out of hours”
and may lead to future deaths.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe your
organisation has the power to take such action.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report,
namely by 27 August 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 following Interested
Person — (Wife of the Deceased)

| 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] 2™ July 2014 [SIGNED BY CORONER]

Responses

1 response 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 University Health Board (PDF)
Ysbyty Gwynedd, Penrhosgarnedd,
Bangor, Gwynedd, LL57 2PW

GIG Bwrdd lechyd Prifysgol
We? Betsi Cadwaladr
H
nN

FA ALES University Health Board Gwynedd Hospital, Penrhosgarnedd,
Bangor, Gwynedd, LL57 2PW

PRIVATE & CONFIDENTIAL Ein oyf / Our ref: P|
Eich cyf / Your ref:

Mr J Gittins
HM Senior Coroner for North Wales (East Rhif Ffon/ Phone: @: Ld

and Central) Gofynnwch am / Ask for: PY

HM Coroner's Office, Ffacs / Fax:

County Hall -bost/Emal: es
Wynnstay Road, E-bost / Email:

Ruthin Dyddiad / Date: 02 September 2014

LL15 1YN

Dear Mr Gittins
Re Regulation 28 ~ Report for the prevention of deaths — Inquest of Ronald Perry

Following the receipt of your letter dated the 2"° July 2014 the Radiology Clinical
Programme Group on behalf of Betsi Cadwaladr University Local Health Board (BCULHB)
has reviewed the services provided and would seek to provide the assurances you
requested.

During the inquest of Mr Ronald Perry, HE gave evidence that there are
variations in the referral criteria for Computerised Tomography (CT) scanning within
BCUHB depending upon the time of day. It was this evidence that gave rise to the
concerns that access to scanning “out of hours” may lead to future deaths.

The Radiology service at all three district general hospital’s in North Wales operates a full
service Monday to Friday 8.30 am to 5.30pm with some scanning lists being extended into
the evenings. This comprises of lists with booked outpatients, urgent suspected cancer
patients, inpatients and clinical emergencies. At all other times a general X-ray service is
offered alongside an emergency on call service for CT and ultrasound scanning. The
emergency on call service is provided on a consultant to consultant basis for all cases
where scanning is required to manage an emergency or life threatening condition.

In the case of Mr Ronald Perry the Radiology Clinical Programme Group understand that a
diagnosis of possible ruptured abdominal aortic aneurysm was not one of the considered
differential diagnosis. The clinical directors for all three departments have confirmed that a
request for this clinical indication would have resulted in a CT scan being performed as an
emergency at any time during the 24 hour period when the referral was made. In Mr
Perry's case no request was made to radiology for a scan to be performed.

As part of continued improvements to the service the Radiology Clinical Programme Group
is working to develop increased access outside of normal office hours. However, in this
particular case had a referral been made with a clinical indication of possible dissecting or
ruptured abdominal aortic aneurysm the level of urgency would have resulted in an urgent
scan being performed, whether in or out of normal working hours.

Cyfeiriad Gohebiaeth ar gyfer y Cadeirydd a'r Prif Weithredwr / Correspondence address for Chairman and Chief Executive:
Swyddfa'r Gweithredwyr / Executives' Office, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW
Gwefan: www.pbc.cymru.nhs.uk / Web: www.bcu.wales.nhs.uk

7Q4\ GIG Bwrdd lechyd Prifysgol
[YM

Betsi Cadwaladr

U
OF N S University Health Board
WALES

If you feel it would be helpful to discuss this response in more detail please contact |_|
a Interim Chief of Staff for Radiology. [EE can be contacted either by
telephone,

The Radiology Clinical Programme group hope that this response provides you with the
reassurance that all patients who are referred for CT scanning with an emergency life
threatening condition are treated in the same way, irrespective of the time.

Yours sincerely

ANGELA HOPKINS
Signed by the Executive Director of Nursing and Midwifery on behalf of the Chief
Executive

CC
mz - Chief of Staff, Radiology Clinical Programme Group
HE ~~ Associate Chief of Staff (Operations), Radiology

Hs — Hlcad of Quality & Governance Radiology

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