Pauline Taylor

Parliamentary under Secretary of State for Health 

 From Dr Dan Poulter MP                                                                                                                                                          

  Richmond House 
      79 Whitehall 
                       London 
        SW1A 2NS 

25th February 2015 

Mr K McLoughlin 
Assistant Coroner 
Coroner’s Office 
71 Northgate 
Wakefield 
WF1 3BS  

Dear Mr McLoughlin,  

Thank you for your letter following the inquest into the death of Pauline Taylor.  
I was very sorry to hear of Ms Taylor’s death and wish to extend my sincere condolences to 
her family. 

In 2010 Ms Taylor underwent a nephroureterectomy procedure to remove her kidney and 
ureter. The surgeon who had decided on this operation envisaged  that this procedure would 
remove the kidney and the entirety of her ureter as far as the bladder wall. However, a 
different surgeon performed the operation and removed approximately 5cm of the ureter, 
leaving the remainder in situ.  

The second surgeon believed the term nephroureterectomy allowed discretion as to the 
proportion of the ureter to be removed. 

This difference in understanding of the term between the two surgeons was not uncovered 
until some months later, by which time Ms Taylor had a tumour in the junction between her 
distal ureter and her bladder which was considered to be inoperable. Following this, 
metastases were also identified in her liver and lungs. The inquest concluded that Ms Taylor 
died from metastatic carcinoma.  

You raise the following concerns: 

  The surgical term ‘nephroureterectomy’ appears to lack sufficient precision to avoid 

misunderstandings between clinicians as to the extent of the procedure to be 
performed. Two surgeons who gave evidence at the inquest differed in their 
understanding of the term – one considered the term involved the removal of a kidney 
and the entire ureter whilst the other surgeon considered the term allowed for the 
removal of only a portion of the ureter.  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   In this case no firm diagnosis had been established and there was no one person in the 
clinical team whose role was to monitor progress and liaise with the patient and the 
other clinicians. Evidence was heard at the inquest about the benefits of a “case 
manager” role, used in other NHS Trusts in complex and uncertain cases.    

I note that you sent a copy of your report to the British Association of Urological Surgeons 
(BAUS), for their interest. 

My officials have liaised with BAUS as the most appropriate organisation to advise 
concerning definition of the term “nephroureterectomy”. In the opinion of BAUS, the term 
nephroureterectomy means the removal of the kidney together with the whole ureter.  BAUS 
have advised that there may be circumstances where it is not possible to remove the whole 
ureter. Where this is the case the finding should be clearly recorded in the notes and 
appropriate arrangements made for follow-up with the patient. 

Decisions on how each clinical team operates and the specific roles within teams are issues 
for the employing Trust. Decisions need to be taken based on the relative skill mix and 
experience of the clinicians involved, as well as the complexity and seriousness of the cases 
handled. Your concern about the lack of a clinical “case manager” in this particular case is a 
matter for the local Trust to address.  

Lastly, it is not clear from this case if any complaint has been made to the General Medical 
Council (GMC).  Concern about a doctor’s fitness to practise should be raised with the 
GMC, as the appropriate regulatory body independent of government.  

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

Best wishes, 

DR DAN POULTER

The Leeds Teaching Hospitals
NHS Trust
PC

Telephone e irios :

Fax:

Our ref:

Your Ref: P| St James's University Hospital

Date: 6th March 2015 Beckett Street
Leeds

Mr Kevin McLoughlin LS97TF

Assistant Coroner Tel: 0113 243 3144

West Yorkshire (Eastern)

Coroner's Office www.leedsth.nhs.uk

71 Northgate

Wakefield

WF1 3BS

Dear Mr McLoughlin
INQUEST TOUCHING THE DEATH OF PAULINE TAYLOR (Deceased)

| refer to your correspondence of 9"" January 2015, received on 16th January, regarding the
inquest touching the death of Pauline Taylor and the Regulation 28 Report to Prevent Future
Deaths in respect of this case.

| can confirm that the recommendations contained within your Regulation 28 have been
shared with the relevant staff to enable us to provide you with a comprehensive response.

We have considered each of the recommendations very carefully and a response to each is
detailed below.

Your first area of concern related to the surgical term ‘nephroureterectomy’ and the apparent
lack of sufficient precision to avoid any possibility of misunderstandings between clinicians as
to the extent of the procedure to be performed. One surgeon gave evidence at the Inquest
that the term involved the removal of a kidney and the entire ureter. Another surgeon,
however, gave evidence that the term was sufficiently broad to allow the removal of only a
portion of the ureter.

Following receipt of your Report, we sought confirmation and advice from the British
Association of Urological Surgeons on the term. They confirmed that the term
nephroureterectomy means the removal of the kidney with the whole ureter. They pointed out
that there may be circumstances where it is not possible to remove the whole ureter. In this
case the finding should be clearly recorded in the notes and follow up arrangements made.

We have emphasised this guidance to all our urological surgeons, anaesthetists and theatre
staff and have made arrangements to ensure it is included in staff induction information so
that all new employees are also clear about the definition.

Chairman Linda Pollard CBE JPDL Chief Executive Julian Hartley

The Leeds Teaching Hospitals incorporating: Chapel Allerton Hospital, Leeds Dental Institute, Leeds Children’s Hospital,
Seacroft Hospital, St James’s University Hospital, The General Infirmary at Leeds, Wharfedale Hospital, Leeds Cancer Centre

Following your Report we consulted with other Trusts, including the Trust that the expert
witness who gave evidence at the Inquest is employed by, to ascertain the role of the case
manager within their organisations.

We established that in other organisations the case manager role is frequently undertaken by
Clinical Nurse Specialists. We confirmed that their processes for assigning nurse specialists
to coordinate care were the same that we use in our cancer centre. At the time of Mrs
Taylor's case a number of these posts were being recruited to. | can confirm that these
posts are now filled and any patient attending clinics with a possible diagnosis of cancer is
assigned a clinical nurse specialist to follow their case and act as a point for communication.

Thank you for bringing these matters to my attention. | do hope that this response has
assured you that the Trust has given careful consideration to the matters of concern you

have raised.
If 1 can be of any further assistance please do not hesitate to contact me.
Kind regards

Yours sincerely

FP suLiaN HARTLEY
Chief Executive
Leeds Teaching Hospitals NHS Trust