Prevention of Future Deaths reports · 2015

Margaret Ferry

Regulation 28 report to prevent future deaths, reference 2015-0450, written 23 Oct 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report23 Oct 2015
Reference2015-0450
DeceasedMargaret Ferry
CoronerKarin Welsh
Coroner areaSunderland
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedCity Hospitals Sunderland NHS Foundation Trust · County Durham and Darlington NHS Foundation Trust
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.

Derek Winter DL
Senior Coroner for the City of Sunderland

LL

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: -
Ms Sue Jacques
Chief Executive Officer
County Durham & Darlington NHS Foundation Trust
Executive Corridor
Darlington Memorial Hospital
Hollyhurst Road
Darlington DL3 6HX
1 CORONER

[am Karin Welsh, Assistant Coroner for the City of Sunderland.
CORONER’S LEGAL POWERS

NO

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.
http://www Jegislation.gov.uk/ukpga/2009/25/schedule/5/paragraph/7

http://www. legislation.gov.uk/uksi/2013/1629/part/7/made

INVESTIGATION and INQUEST

ies)

On 14" May 2015 I commenced an investigation into the death of Margaret Anne Ferry,
aged 66. The investigation concluded at the end of the Inquest on 20" October 2015.

The conclusion of the Inquest was that Margaret died as a result of the progression of a
naturally occurring disease process but opportunities to ameliorate that process were lost
as a consequence of a lack of communication.

The medical cause of death was: -

la Bronchopneumonia

Ib Necrotising Fasciitis

and

II Diabetes Mellitus; Raised Body Mass Index
4 CIRCUMSTANCES OF THE DEATH

Margaret had a number of underlying health issues and was admitted to Sunderland
Royal Hospital on 8" January 2015. She underwent a planned amputation of her left 5"
toe on 11" January. Thereafter she developed a deterioration to her skin integrity
particularly around her abdomen and thighs. On 6" March a referral was made to the
plastic surgery team at University Hospital of North Durham. Their role was to provide
advice to the treating doctors in Sunderland.

There was no clear understanding in each hospital of the role of the other in Margaret’s
care. There was no clear understanding of the different practices and procedures in each
hospital and the impact this would have on Margaret. There was inadequate

Civic Centre, Burdon Road,Sunderland, SR2 7DN
Tel 0191 5617843 | Fax 01915537803 | DX 60729 Sunderland
www.sunderland.gov.uk/coroner

communication, both written and oral, between the various doctors involved in
Margaret’s care. Although Margaret was seen by a number of health professionals,
including doctors, there was a lack of leadership, meaning that there was no cohesive
treatment plan.

On 22"! April 2015 Margaret underwent a debridement procedure which, although in
itself successful, the missed earlier opportunities meant that Margaret’s underlying
health problems had been exacerbated and she died on 12'" May 2015.

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. Evidence was given at the Inquest that there was no policy in place between City
Hospitals Sunderland NHS Foundation Trust and County Durham and Darlington
NHS Foundation Trust clarifying the areas of responsibility and channels of
communication between the two when patients are referred.

2. Evidence was given that there were poor levels of communication both direct and
indirect between medical professionals at each trust and poor understanding of
each other’s differing practices and procedures.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I believe you 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 18th December 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: -

e City Hospitals Sunderland NHS Foundation Trust and their Solicitors

e Family

e CQC

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 this 23" day of October 2015

Signature !
Assistant Coroner for the City of Sundetland
Also filed under 2015-0450: Ferry-2015-0450.pdf
Derek Winter DL
Senior Coroner for the City of Sunderland

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: -
Mr Ken W Bremner
Chief Executive
City Hospitals Sunderland NHS Foundation Trust
Sunderland Royal Hospital
Kayll Road
Sunderland SR4 7TP

CORONER

I am Karin Welsh, Assistant Coroner for the City of Sunderland.

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.

http://www. legislation. gov.uk/ukpga/2009/25/schedule/5/paragraph/7

http://www. legislation. gov.uk/uksi/2013/1629/part/7/made

INVESTIGATION and INQUEST

On 14" May 2015 I commenced an investigation into the death of Margaret Anne Ferry,
aged 66. The investigation concluded at the end of the Inquest on 20" October 2015.

The conclusion of the Inquest was that Margaret died as a result of the progression of a
naturally occurring disease process but opportunities to ameliorate that process were lost
as a consequence of a lack of communication.

The medical cause of death was: -
la Bronchopneumonia
Ib Necrotising Fasciitis
and
I] Diabetes Mellitus; Raised Body Mass Index

CIRCUMSTANCES OF THE DEATH

Margaret had a number of underlying health issues and was admitted to Sunderland
Royal Hospital on 8" January 2015. She underwent a planned amputation of her left 5""
toe on 11" January. Thereafter she developed a deterioration to her skin integrity
particularly around her abdomen and thighs. On 6" March a referral was made to the
plastic surgery team at University Hospital of North Durham. Their role was to provide
advice to the treating doctors in Sunderland.

There was no clear understanding in each hospital of the role of the other in Margaret’s
care. There was no clear understanding of the different practices and procedures in each
hospital and the impact this would have on Margaret. There was inadequate
communication, both written and oral, between the various doctors involved in

Civic Centre, Burdon Road,Sunderland, SR2 7DN
Tel 0191 5617843 | Fax 0191 5537803. | DX 60729 Sunderland
www.sunderland.gov.uk/coroner

Margaret’s care. Although Margaret was seen by a number of health professionals,
including doctors, there was a lack of leadership, meaning that there was no cohesive
treatment plan.

On 22" April 2015 Margaret underwent a debridement procedure which, although in
itself successful, the missed earlier opportunities meant that Margaret’s underlying
health problems had been exacerbated and she died on 12" May 2015.

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. Evidence was given at the Inquest that there was no policy in place between City
Hospitals Sunderland NHS Foundation Trust and County Durham and Darlington
NHS Foundation Trust clarifying the areas of responsibility and channels of
communication between the two when patients are referred.

2. Evidence was given that there were poor levels of communication both direct and
indirect between medical professionals at each trust and poor understanding of
each other’s differing practices and procedures.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I believe you 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 18th December 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: -

e County Durham and Darlington NHS Foundation Trust and their Solicitors and Counsel
e Family

e CQC

Tam 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 this 23" day of October 2015

Signature Lou TNA
Assistant Coroner for the City of Sunderland

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 Respondent Not Named (PDF)
Executive Corridor 
Darlington Memorial Hospital 
Hollyhurst Road 
Darlington, DL3 6HX 

e-mail: 

Our Ref: SJ/bc/KWelsh 

17th December 2015 

Karin Welsh 
Assistant Coroner for City of Sunderland 
Civic Centre 
Burdon Road 
Sunderland 
SR2 7DN 

Regulation 28 Report to prevent future deaths  

Dear Karin  

Please see the response from the Trust, County Durham and Darlington Foundation Trust, detailing 
the actions that have been taken following the concerns that you raised after the inquest held for the 
late Mrs Margaret Anne Kelly.  

In your correspondence you raised two main issues of concern:-   

1.  Evidence was given at the Inquest that there was no policy in place between City Hospitals 

Sunderland NHS Foundation Trust and County Durham and Darlington NHS Foundation Trust 
clarifying the areas of responsibility and channels of communication between the two when 
patients are referred.  

2.  Evidence was given that there were poor levels of communication both direct and indirect 
between medical and professionals at each trust and poor understanding of each other’s 
differing practices and procedures.  

We have recognised that there were significant gaps in the provision of services to Margaret 
therefore, Anne Ferry, City Hospitals Sunderland, and the Trust have worked closely with our 
colleagues at City Hospital Sunderland to address the issues raised.  In collaboration we have 
developed a new standing operational procedure to provide a comprehensive approach to inter 
organisational referrals for plastic surgery opinions.  The standard operating procedure provides a 
process to ensure that the referral is clearly documented; that a suitable response is provided within 
clearly defined timescales, and that it is clear to all parties that patients on wards at Sunderland Royal 
remain under the care of the admitting consultant at all times, and not the plastics team. I have 
included this for your information.   

www.cddft.nhs.uk 
Chief Executive.  Darlington Memorial Hospital, Hollyhurst Road, 
Darlington, County Durham DL3 6HX   

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Please don’t hesitate to contact me if you require any further on this issue  

Yours sincerely 

Sue Jacques 

CHIEF EXECUTIVE 

cc. Ken Bremner 

www.cddft.nhs.uk 
Chief Executive.  Darlington Memorial Hospital, Hollyhurst Road, 
Darlington, County Durham DL3 6HX

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