Prevention of Future Deaths reports · 2015

Brian Gillard

Regulation 28 report to prevent future deaths, reference 2015-0244, written 26 Jun 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report26 Jun 2015
Reference2015-0244
DeceasedBrian Gillard
CoronerAlan Walsh
Coroner areaManchester (West)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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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. Dr Jackie Bene, Chief Executive, Trust Headquarters, Royal Bolton
Hospital, Minerva Road, Farnworth, Bolton, BL4 0JR

CORONER

Iam 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 31% March 2015 I commenced an Investigation into the death of Brian
Anthony Gillard, 79 years, born 12 June 1935. The Investigation concluded at
the end of the Inquest on 11" June 2015.

The medical cause of death was 1a) Congestive cardiac failure, 1b) Asbestosis.
The conclusion of the inquest was Industrial Disease.
CIRCUMSTANCES OF THE DEATH

1. Brian Anthony Gillard died at the Royal Bolton Hospital, Minerva Road,
Farnworth, Bolton on the 20" March 2015.

. Mr Gillard had been exposed to asbestos during his working life at
various locations and at various times between 1951 and 1999 when he
worked as a Pipe Lagger. In July 2014 Mr Gillard presented to the
Respiratory Service at the Royal Bolton Hospital, Bolton with a six month
history of rapidly progressive breathlessness and , subsequently, he was
diagnosed as suffering with Asbestosis. He was treated on Oxygen at
home from September 2014 after seeing a Consultant Respiratory
Physician at the Hospital and he was reviewed on a monthly basis by
various Respiratory Nurses with regard to his Oxygen requirements.

. On the 28" February 2015 Mr Gillard was admitted to the Royal Bolton
Hospital, Bolton with a history of recurrent collapses and by this time he
was known to be on long term Oxygen therapy for breathlessness due to
Pulmonary Fibrosis. During his time in Hospital Mr Gillard was noted to
have increased Oxygen requirements and the Respiratory Nurses

arranged for him to have increased Ambulatory Oxygen at home, which
was delivered to his home address at the time of his discharge on the
14" March 2015.

. On the 18" March 2015 at 17.20 hours Mr Gillard attended the
Emergency Department of the Royal Bolton Hospital, Bolton by
ambulance and it was known that he had a past medical history of
Asbestosis and he was on long term Oxygen therapy. He presented to
the Hospital with increased shortness of breath, low Oxygen saturations
and poor mobility. The Respiratory Nurses had seen him in the
community and the Nurses advised his admission to the Hospital. After
preliminary investigations he was treated for pneumonia pending a chest
x-ray and the chest x-ray showed increased right sided congestion. He
was using Oxygen during transfer from his home address to the Hospital
in the ambulance and he continued to use Oxygen in the Emergency
Department at the Hospital.

He was known to require Ambulatory Oxygen from the Hospital notes in
relation to his previous admission and at the time of his admission to the
Emergency Department at the Hospital.

. Mr Gillard had arrived at the Emergency Department at the Hospital at
17.20 hours on the 18" March 2015 and later that evening he was
transferred from the Emergency Department to D1 Ward at the Hospital.

. Mr Gillard was taken to D1 Ward "t a Hospital Porter and he was

received on D1 Ward by , who is an Assistant Practitioner.
WE gave evidence at the Inquest that he did not receive a formal
handover from the Emergency Department and he was not aware that
Mr Gillard required Ambulatory Oxygen.

also gave evidence that there was no system in place at the
Hospital in relation to handover from the Emergency Department to the
Ward, particularly in relation to Oxygen requirements.

. At approximately 05.30 hours on the 19" March 2015 Mr Gillard was in
bed when he requested the toilet and he was offered a commode next
to his bed. However, Mr Gillard insisted that he be taken to the toilet
and took him to the toilet in a wheelchair without continuing
Oxygen. [J accepted that portable Oxygen supply was available
for use between the Hospital bed and the toilet but Mr Gillard was happy
to go to the toilet without Oxygen and] was not aware that Mr
Gillard required Ambulatory Oxygen.

. When Mr Gillard was taken to the toilet he was left in the toilet, which
did not have an Emergency pull-cord, for privacy andreturned
to his duties for three to four minutes leaving Mr Gillard in the toilet on
his own.

When returned to the toilet approximately four minutes later
he found Mr Gillard collapsed behind the toilet door and Mr Gillard had

suffered a cardiac arrest believed to be due to Hypoxia. Mr Gillard was
resuscitated and he was transferred to his bed.

A repeat chest x-ray showed worsening congestion and subsequent
clinical assessment revealed a raised JVP and bilateral chest crepitations.

Mr Gillard was treated with intravenous diuretics, intravenous antibiotics
and increased oxygen support but on the 20" March 2015 he
deteriorated and died.

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, Mr Gillard had been diagnosed with Asbestosis and he was
started on Oxygen at home after seeing a Consultant Respiratory
Physician and a Specialist Respiratory Nurse on the 8" September
2014. He was reviewed on a monthly basis by various
Respiratory Nurses with regard to his Oxygen requirements.

During his admission to the Royal Bolton Hospital on the 28
February 2015 his oxygen requirements increased and he was
seen by the Respiratory Nurses who arranged for him to have
increased Ambulatory Oxygen at home following his discharge
from the Hospital on the 14” March 2015.

When Mr Gillard was admitted to the Royal Bolton Hospital
Emergency Department on the 18" March 2015 he was receiving
Oxygen and he was known to require Ambulatory Oxygen, which
continued until he was transferred to D1 Ward at the Hospital.

There was no handover in relation to Mr Gillard’s transfer from
the Emergency Department at the Hospital to D1 Ward at the
Hospital, particularly in relation to his need for Ambulatory
Oxygen and subsequently he was taken to the toilet without the
use of Oxygen. He was left in the toilet on his own, and without
supervision by a Nurse outside the door, for approximately four
minutes during which he suffered a cardiac arrest believed to be
secondary to Hypoxia.

It was accepted that there was a facility to use a portable
Oxygen supply for use between his bed and the toilet but the
portable supply was not used because Mr Gillard was happy to go
to the toilet without Oxygen and his need for Ambulatory Oxygen
was not known to the Ward Staff on D1 Ward.

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

The handover of patients from one department to another
department within the Hospital particularly in relation to the need
for Oxygen and other treatment.

The use of portable Oxygen units for the supply of Oxygen to a
patient whilst being transferred from the bed to the toilet or any
other facility within a Ward at the Hospital.

The information available to Ward Staff and the knowledge of
Ward Staff when receiving a patient to the Ward, particularly in
relation to necessary and continuing treatment and the need to
identify and highlight the continuation of necessary treatment,
particularly in relation to the use of Oxygen.

The training of all staff in relation to the transfer of patients from
one department to another department in the Hospital and the
need to identify and highlight the need for necessary treatment
to continue, particularly in relation to the use of Oxygen.

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

ACTION SHOULD BE TAKEN

In my opinion urgent action should be taken to prevent future deaths and I
believe you and 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 21* August 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. i Mr Gillard’s wife
2. EE \' Gillard’s daughter

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.

_ a
26" June 2015 Alan P Wals

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