Prevention of Future Deaths reports · 2016

Danielle Robinson

Regulation 28 report to prevent future deaths, reference 2016-0205, written 31 May 2016. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report31 May 2016
Reference2016-0205
DeceasedDanielle Robinson
CoronerJohn Gittins
Coroner areaNorth Wales (East and Central)
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Suicide (from 2015)
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 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 20" November 2014 | commenced an investigation into the death of Danielle Rhian
Robinson aged 21. The investigation concluded at the end of the Inquest held with a jury
on the 25" of May 2016. The conclusion of the Inquest was that Miss Robinson’s death
was the result of Misadventure. The medical cause of death was l(a) Post Cardiac
Arrest Hypoxic Brain Injury with Cerebral Oedema due to 1(b) Ligature Strangulation

4 | CIRCUMSTANCES OF THE DEATH

(1) Miss Robinson was a 21 year old who was detained under s.3 of the Mental
Health Act at the Heddfan Unit of Wrexham Maelor Hospital. During the time
she was a patient at Heddfan she had repeatedly self harmed, primarily by the
placing of ligatures around her neck.

(2

SS

On the 13" of November 2014 she was found unresponsive in her room with a
ligature around her neck. At this time, despite earlier episodes of both self harm
and absconding from the unit she was on level 1 observations (being every
three hours). Despite resuscitation attempts and subsequent treatment she died
on the 16! of November 2014.

5 | 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) That the Therapeutic Engagement and Observation Policy presently
adopted by BCUHB is not being rigorously followed by staff with the
result that opportunities to escalate the level of observations when
required are being missed.

(2) That the current Therapeutic Engagement and Observation Policy there
should be reviewed with consideration being given to implementing a
system for situations where there is a serious event which places a patient
at risk of immediate or imminent harm, that there should be an automatic
escalation of observation levels to level 3 or 4 (within eyesight or arm’s
length respectively) for a designated period and/or one to one engagement
with the patient so as to provide an instant “safety net”.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe your
organisations 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 27 July 2016 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

| have sent a copy of my report to the Chief Coroner and to the following Interested
Person: ATC rents 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] 315 May 2016 SIGNED BY SENIOR CORONER]

CAKE

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)
Heddfan AMHU, 
Ysbyty Maelor Wrecsam, Wrecsam,  
LL13 7TD 
---------------------------------- 
Heddfan AMHU, 
Wrexham Maelor Hospital, Wrexham,  
LL13 7TD 

Ein cyf / Our ref: 

Eich cyf / Your ref: 

Ffôn / Telephone: 

Gofynnwch am / Ask 
for: 

E-bost / Email: 

Dyddiad / Date: 

27 July 2016  

Mr J A Gittins 
H M Coroner 
Coroner’s Office 
County Hall 
Wynnstay Road 
Ruthin 
LL15 1YN 

Dear Mr Gittins 

In response to the Regulation 28, issued on May 28th 2016 as a result of the inquest into 
the  death  of  Miss  Danielle  Rhian  Robinson.    I  can  confirm  that  the  BCUHB  Therapeutic 
Engagement  and  Observation  Policy  has  been  reviewed  and  updated  to  include  the 
automatic  escalation  of  observations  following  serious  attempt  of  self-harm  until  a  full 
multi-disciplinary  team  (MDT)  review  can  take  place,  a  copy  is  enclosed  for  your 
information.    

Roles and responsibilities of all staff are clearly detailed within the policy.  In relation to the 
ongoing monitoring of compliance, an audit process is included which will now form part of 
the  divisional  audit  cycle  with  outcomes  and  suggestions  for  improvements  formally 
reported through our divisional governance structure to QSE.   

The division has its first learning event planned for September 2016 and the policy will be 
formally re-launched at this event. 

Yours sincerely 

Cyfarwyddwr Iechyd Meddwl ag Anabledd Dysgu  
Director of Mental Health and Learning Disabilities 

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

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