Prevention of Future Deaths reports · 2014

Jade Anderson

Regulation 28 report to prevent future deaths, reference 2014-0530, written 5 Dec 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report5 Dec 2014
Reference2014-0530
DeceasedJade Anderson
CoronerAlan Walsh
CategoryOther 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)

NOTE: This form is to be used after an inquest.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

1, Lord De Mauley, Department for Environment, Food and Rural Affairs,
House of Lords, London, SW1A OPW

CORONER

I am Alan Peter Walsh, Area Coroner, for the Coroner Area of Manchester West

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.

INVESTIGATION and INQUEST

On 27" March 2013 I commenced an investigation into the death of Jade Sarah
Louise Lomas Anderson, 14 years, Born on 9" March 1999. The investigation
concluded at the end of the inquest on the 24" October 2014.

The medical cause of death was 1a) Multiple Injuries.

The conclusion of the inquest was Jade Sarah Louise Lomas Anderson died as a
consequence of injuries sustained by her when she was attacked by more than
one dog.

CIRCUMSTANCES OF THE DEATH

1. Jade Sarah Louise Lomas Anderson died ti

bn the 26" March 2013.

2. At the time of her death Jade was visiting a friend, called | atl
and she had stayed overnight at
the address from the 25" March 2013 into the 26" March 2013.

3. She was attacked by more than one dog at the address at or about
14:20 hours on the 26" March 2013 when she was alone in the
premises. She suffered multiple injuries consistent with multiple dog
bites by more than one dog. The attack occurred i who
resided at the premises, left the premises for a short time to visit a
neighbour and there was no other person present in the premises at the
time of the attack.

4. The occupiers of the premises had five dogs namely two large Mastiffs

called Buddy and Neo, two Staffordshire Bulldogs called Ty and Skye and
one Shih Tzu called Charlie. The Shih Tzu called Charlie was kept in a
cage in the lounge at the premises and Charlie remained in the cage
during the attack. The two large Mastiffs and the two Staffordshire
Bulldogs were kept in the kitchen in the premises with the Mastiff called
Buddy in a cage secured with bolts and dog clips.

5. | who was 16 years of age at the time of Jade’s death, was
residing at : : with her mother and
step-father. At or about 13:00 hours on the 26" March 2013 her parents
left the premises to go sho leaving EEEMMand Jade alone in the
premises. Before they left # put the dogs into the garden of the
premises so that the dogs did not = _— when her parents were
leaving. After her parents had left took Jade through to the
living room of the [iccured and then brought the dogs back into the

kitchen secured the large Mastiff called Buddy in the cage in
the kitchen with the bolts and the dog clips. closed the
kitchen door leaving the three remaining dogs free to roam in the
kitchen and she then put the Shih Tzu called Charlie in the cage in the
living room.

6. At or about 14) i nd went to a
neighbour a to warm a pie for
Jade's lunch because the Microwave in the premises was broken. Jade
stay a romises whilst J went to the neighbours’ house
and left Jade in the living room with the door to the kitchen

closed. Wher returned, approximately five minutes later, she

opened the door to the kitchen and saw Jade on the floor of the kitchen

with all the dogs, apart from the Shih Tzu, surrounding her. ii

ran back to the neighbours’ address and the Emergency Services were

called. When the Emergency Services arrived Jade was found deceased
in the kitchen at the premises. The Shih Tzu was still in the cage in the
living room and the four other dogs were roaming free.

7. The Emergency Services discovered that the large Mastiff called Buddy
had escaped from the cage in the kitchen at the premises. The cage in
the kitchen was found to be bent out of shape with a broken dog clip in
the bottom of the cage. The door on the cage had been secured by two
sliding bolts. The top bolt was still in place but the lower bolt was not in
its securing loop. A police officer was able to pull the bottom of the door
away from the cage, without much effort, leaving a gap through which a
dog would be able to escape.

8. At the Inquest a Forensic Pathologist, gave evidence

that she was satisfied that the dog bites causing the multiple injuries and
leading to Jade's death had been caused by more than one dog although
she could not be satisfied as to the number of dogs involved in the
attack.

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. During the Inquest evidence was heard that

i. Jade died when she was attacked by more than one dog, who were
out of control at the time of the attack. It is likely that the attack
occurred when Jade went into the kitchen and the evidence indicated
that she may have gone into the kitchen to answer a mobile
telephone which had been left in the kitchen and which was known
to have received a call at or about the time of the attack.

ii. _An inspection of the premises at Pl
a revealed a sign to the left of the front door ‘Beware of

the Dog - Enter at_your own Risk’. The premises were small and
housed two adults, a five dogs, a cat and a parrot. The
dogs of the type and number described raised concerns with regard
to potential problems in relation to interaction and dominance issues
in a confined area. There was no evidence of dog toys or purpose
made dog beds to keep the dogs occupied and provide enrichment
for them and there was no evidence of any dog collars or leads
within the premises. There was no evidence that the dogs were
given regular exercise or went out of the premises, other than to
roam in the confined space of the rear garden.

ii. In the past four years the number of dog bite incidents that required
hospital treatment has risen by 26% and the number of convictions
for possessing prohibited dog types (three dog types) has risen by
146% whilst the number of convictions for not keeping dogs under
control rose by 5%, which indicates that the approach set out in
current Legislation is not working and continues to put public safety
and animal welfare at risk.

iv. The Legislation on dog control is scattered amongst many different
pieces of Legislation and this does not include a range of secondary
legislation. The main pieces of Legislation are within more than 10
statutes commencing with the Metropolitan Police Act 1839 and
culminating in the Anti-Social Behaviour, Crime and Policing Act
2014, which comes into force in England and Wales in May 2014.

The provisions of the Anti-Social Behaviour, Crime and Policing Act
2014 were welcomed during the evidence but the evidence was that
the recent Legislation did not go far enough to address the problem
of the control of dogs, which had led to an increase in dog bite
incidents.

The evidence indicated that only consolidated and updated

vi.

vii.

Legislation would ensure that the public, owners of dogs and
enforcers of the Legislation have a clear understanding of what is
expected and what powers can be used.

The current Legislation provides for controls over the possession of
four types of dogs and the Legislation is breed specific by reference
to the type of dog rather than the behaviour of a dog. The evidence
was that the behaviour of a dog is more important than the breed.

The Legislation is supported by a considerable amount of case law
determining aspects of different pieces of Legislation, which often
results in confusion amongst law enforcement practitioners (for
example, dog wardens, police officers and other agencies) in
selecting the best piece of Legislation to use leading to a lack of
effective and consistent enforcement throughout England and Wales.
This has often resulted in confusion amongst the public in terms of
what is expected of them as responsible dog owners, as well as
which agency should receive a complaint. An update and
consolidation of dog control Legislation based upon up-to-date
scientific understanding of dog behaviour and in particular
aggression, which is not based upon a breed specific approach would
assist front-line practitioners in relation to the control of dogs and
the enforcement of Legislation so that the number of serious
incidents could be reduced and prevented.

The evidence indicated that Legislation should not be based upon a
breed specific approach and instead focus on the behaviour of the
dog and the owner / person responsible for the dog. Furthermore it
should allow for significantly earlier intervention so that serious
incidents could be prevented.

The Legislation tends to be reactive rather than proactive so it is
difficult to prevent serious incidents from occurring.

The evidence indicated that if the Legislation was proactive
enforcement would be available at an early stage prior to incidents
having occurred and would lead to the prevention of serious
incidents.

The key aspect that is missing from the current approach to tackling
dog bites is educational awareness about staying safe around dogs.

The RSPCA is currently developing an education package for schools,
families and others that provide simple and clear information about
dog behaviour and in particular the signals dogs can give when they
are stressed or uncomfortable in a situation. During the course of
evidence I received a leaflet produced by the RSPCA and named
‘Dogs and Children, a Guide to staying safe’ with six golden rules for
keeping a child safe and a dog happy.

The evidence indicated that a coordinated approach to ensure that
all ‘at_risk’ groups receive consistent and up to date information

about dog behaviour is needed and other groups of people that may
benefit from such an approach would be those who deliver to
properties and services providers.

Problems arising from the lack of control of dogs increases with an
increase in the number of dogs in the country. The evidence was
that there are nine and a half million dogs in the country and the
practice of dog trafficking from abroad is prevalent, which increases
the problem of dog control.

The evidence indicated that the Licencing of dogs with central
records would assist front-line practitioners in the control of dogs
and the enforcement of Legislation.

The evidence indicated that a key issue in the control of dogs is to
make owners responsible for their dogs and dog owners need to
take sufficient steps to ensure that their pets are well socialised and
under control so that they do not pose a risk to other people. The
care of dogs, including proper exercise, and the provision of dog toys
and purpose made dog beds, for example, would keep dogs
occupied and provide enrichment for them, which would reduce the
number of dog bite incidents. There is a need to educate dog owners
in relation to such matters.

The evidence raised concerns that there is a risk that future deaths
will occur unless action is taken to review the above issues.

2. I request you to consider the above concerns and to carry out a review
with regard to the following :-

The consolidation of existing Legislation in relation to dog control to
include secondary Legislation.

The Legislation relating to the control of dogs to be proactive, and
not reactive, and the behaviour of the dog should be the focus of the
Legislation rather than the present breed specific Legislation.

The Legislation to focus on the responsibility of dog owners for the
control of their dogs.

The Licensing of all dogs with a system of central records to assist
the control of dogs and the enforcement of legislation.

The training and education of dog owners and children in relation to
the control of dogs and the welfare of dogs to raise awareness about
staying safe around dogs and the signals that dogs can give when
they are stressed or uncomfortable in situations which are likely to
lead to the risk of dog bites. Consideration of the dissemination of
material and information either by leaflets or by use of the media
could be included in the review.

Enforcement of the Legislation, to include a training programme for

Police and Local Authorities to deal with complaints and enforcement
of the Legislation.

Iam aware that front-line practitioners, including the RSPCA, would be prepared
to participate in any consultation process as part of a review.

ACTION SHOULD BE TAKEN

In my opinion urgent action should be taken to prevent future deaths and I
believe you and the Government your organisation have 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 30" January 2015. 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.

COPIES and PUBLICATION

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

1)
2) Local Safeguarding Board.

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.

Dated Signed

5 December 2014 Alan P Walsh

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 Department for Enviroment Food and Rural Affairs (PDF)
,. Department 

for Environment 
Food & Rural Affairs 

Mr AP Walsh 
HM Area Coroner 
Paderborn House 
Howell Croft North 
Bolton BL 1 1 QY 

RIEC!ellV!ED 
02  FEB 2015 

----------------

helpline@defra.gsi.gov.uk 
www.gov.uk/defra 

Nobel House 
17 Smith Square 
London SW1 P 3JR 

lg January  2015 

From Lord de Mauley 
Parliamentary Under Secretary of State for Natural Environment and Science 

Thank you for your letter of 8  December with  which you enclosed  a  report of the death  of 
Jade Anderson together with your recommendations for action. 

Let  me  first say I  was  deeply  saddened  to  hear of the  death  of Jade  Anderson  and  the 
circumstances  in  which  it  happened.  I  have  met  Jade's  mother  and  step-father  and  on 
behalf of the whole of the Government we  pass on  our condolences to Jade's  family  and 
friends for their tragic loss. 

The Government is serious about tackling irresponsible ownership of dogs which is why we 
, 
have recently changed the existing law in two important respects. 

In May last year we extended the scope of the Dangerous Dogs Act 1991  so that it is now 
an offence to allow any dog to be dangerously out of control  in  any place,  including  inside 
the  dog  owner's  property.  At  the  same  time,  we  increased  the  maximum  penalty  for 
allowing  a  dog  to  be  dangerously  out  of  control  and  it  killing  someone  from  2  years' 
imprisonment to 14 years;  and  if the dog  injures  someone the increase was from  2 years' 
imprisonment to 5 years.  In addition, there  is  also a separate offence of allowing  a dog to 
attack an assistance dog which attracts a maximum sentence of 3 years' imprisonment. 

It is  important to  understand  that the  Dangerous Dogs Act  1991  is not just about banning 
certain  types  of dog.  It also makes  it an  offence to allow any dog of any breed  or type to 
become dangerously out of control.  It therefore covers both deed and breed. 

We have  also responded  to  calls for the  law to  be more proactive.  To this end,  we  made 
sure that the new measures to deal with  anti-social behaviour, in  the Anti-social Behaviour, 
Crime  &  Policing  Act  2014,  could  be  used  to  tackle  such  behaviour  when  it  involves 
irresponsible ownership of a  dog.  These  new laws  mean  that police  and  local  authorities 
now have powers to intervene in cases of low level dog nuisance, before a serious incident 
occurs - for example,  a  dog  running  loose  in  a  park or near a  road,  a dog that threatens 
visitors or even a situation where there are too many dogs on a property and  it is having a 
detrimental effect on the quality of life of those in the locality.  This means that action can be 

V'~

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)  INVESTORS 
t¥~.t"'" 
-:~,,..\._t  ~ j  IN PEOPLE 

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 taken  before a dog becomes dangerous.  The new powers came into effect on  20 October 
2014. 

To  help the  police  and  local authorities  use the new measures appropriately,  Government 
produced  a  comprehensive  Practitioner's  Manual.  You  can  find  the  Manual  on  this  link: 
https://www.gov.uk/government/oublications/dealinq-with-irresponsible-dog-ownership-
practitioners-manual  The Manual  was  drawn  up  with  the  cooperation  of the practitioners 
themselves  and  animal  welfare  charities  and  has  been  widely  welcomed.  There  are  a 
number of scenarios  envisaged  in  the  document which  help  the  practitioners  deal  with  a 
range  of  specific  incidents  they  might  face,  including  complaints  relating  to  dogs  on  a 
property. 

In  addition  to  the  manual  there  is  also  a  comprehensive  training  programme  for  police 
officers on the new laws on  dogs. The police, in particular, are responsible for enforcing the 
law  on  dangerous  dogs.  Despite  the  law  on  dangerous  dogs  being  in  more  than  one 
statute,  which  is  not unusual,  the police have specifically trained  officers to deal with  such 
complaints  - Dog  Legislation  Officers  (DLOs).  Nearly  all  forces  have  DLOs  and  where 
these are  not available,  they can  be obtained from  neighbouring forces.  Local  authorities 
also have access to dedicated Dog Wardens to deal with stray and  displaced dogs.  These 
too  are  specifically  trained  to  handle  dogs  and  are  familiar  with  the  law  in  this  area.  I 
therefore consider that training is already available to enforcers and that consolidation of the 
legislation on dangerous dogs is not a priority. 

You  also  requested  the  re-introduction  of the  dog  licence.  Compliance  rates  in  countries 
where such a scheme operates currently are not very high - typically around 40% or 50%. 
Indeed, this was one of the reasons the dog licence was abolished  in this country in 1988. 
A  low  rate  of compliance  makes  it  difficult  for  a  dog  licensing  scheme  to  be  effective. 
However,  whilst I do  not support dog  licensing,  I do  support compulsory  microchipping  of 
dogs.  Microchipping  has  clear advantages  for both  dog  and  owner  in  that they  can  be 
reunited  much  quicker if the dog  strays  or is  lost. 
It provides  a  permanent  link  between 
owner and dog.  There will  be a link between  the available microchip  databases to ensure 
that  the  owner  of  a  dog  can  be  ascertained  quickly.  Since  we  announced  compulsory 
microchipping will be introduced in April 2016 numbers of dogs that are microchipped have 
risen  from  around  58%  to  70%  which  shows  that  owners  can  see  the  benefits. 
Microchipping of dogs will not necessarily prevent dog attacks but it does encourage a level 
of responsibility  in  the  owner and  will  achieve  some of the desired  benefits  of a  licensing 
scheme. 

I also note what you say about education and training of children around dogs.  As you point 
out, there is already good work being carried out by the RSPCA in this area.  Similarly, the 
Dogs  Trust,  Battersea  Dogs  &  Cats  Home  and  the  Kennel  Club  all  provide  helpful  advice 
about children and dogs, and we have been able to give them financial support to help them 
with this work.  As the recognised experts in this area,  I think the charities are better placed 
to give this advice to dog owners and keepers, and they are more likely to be heeded than a 
Government  leaflet.  We  and  the  charities  are  also  working  with  the  leading  websites 
carrying advertisements for dogs to improve information for owners. 

Overall,  I consider that the actions we  have taken  recently,  and  those we are proposing to 
take,  will  have a  positive  impact on  instances of irresponsible  dog  ownership.  Thank you 
once again for your letter and report. 

( ' \ INVESTORS 
~_,/ IN  PEOPLE

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