Prevention of Future Deaths reports · 2016
Regulation 28 report to prevent future deaths, reference 2016-0339, written 23 Sep 2016. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 23 Sep 2016 |
|---|---|
| Reference | 2016-0339 |
| Deceased | Karnel Haughton |
| Coroner | Emma Brown |
| Coroner area | Birmingham and Solihull |
| Category | Other related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | none published |
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 THIS REPORT IS BEING SENT TO: e The Department For Education ° The NSPCC CORONER ! am Emma Brown Area Coroner for Birmingham and Solihull 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. INVESTIGATION and INQUEST On 06/06/2016 | commenced an investigation into the death of Karnel Kane Haughton. The investigation concluded at the end of an inquest on 20th September 2016. The conclusion of the inquest was that Karnel’s death was a result of misadventure. CIRCUMSTANCES OF THE DEATH Karnel passed away at the age of 12 at the Birmingham Heartlands Hospital on the 1st June 2016 at 22:37 having been found unconscious at his home about 90 minutes earlier with a ligature loose around his neck that was attached to a bannister. It is likely that Karnel had been trying to experience the sensation of passing out, or coming close to passing out, and regaining consciousness without realising the extreme risk he was taking. Following a post mortem the medical cause of death was determined to be: 1(a) LIGATURE STRANGULATION 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. Karnel was likely to have been engaging in an activity known as the ‘choking game’ where pressure is applied to the neck by means of some sort of ligature to induce a sensation of near or actual fainting. , 2. Several witnesses gave evidence that on the internet, on sites such as you tube, there are thousands of videos of children and adolescents engaging in the ’Choking Game’, the ‘Pass out Challenge’ and other activities whereby the children either on their own or with the assistance of others deliberately induce the sensation of fainting or passing out by various means, these videos are openly accessible, uncensored and contain no warnings. 3. Information received by the West Midlands Police indicated that there have been other incidents of children being seriously injured as a result of these sorts of activities across the country. 4. Although local guidance and information for teachers has been issued by Birmingham City Council as a result of Karnel’s death there is no national guidance for schools or youth groups to alert them to these activities, the risks and provide details of warning signs. 5. There is no charity or other institution which provides support and guidance to parents or children specifically on these activities if they have a concern. 6. Leaving the raising of national awareness on this topic solely to the media is dangerous because there is a real risk that if the subject matter is not handled carefully children will be incited to experiment with these sorts of activities. ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and | 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 17" November 2016. t, 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 Persons: Karnel’s — EE | an required to send a copy to the Local Safeguarding Board and | have also sent it to [MJ of the Greenwood Academy and West Midlands Police who may find it useful or of interest. 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. 23/09/2016 Signature Miss Emma Brown Area Coroner Birmingham and Solihull Areas
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