Prevention of Future Deaths reports · 2017

Lyndsey Holt

Regulation 28 report to prevent future deaths, reference 2017-0096, written 29 Mar 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report29 Mar 2017
Reference2017-0096
DeceasedLyndsey Holt
CoronerNicola Mundy
Coroner areaSouth Yorkshire (East)
CategoryCommunity health care and emergency services related deaths
Organisation namedYorkshire Ambulance Service NHS Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

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.

Ms N J Mundy
Senior Coroner for South Yorkshire (East District)

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: The Chief Executive, Yorkshire Ambulance Service
NHS Foundation Trust, Trust Headquarters, Springhill, Brindley Way, Wakefield 41 Business
Park, Wakefield WF2 0XQ

CORONER

lam Ms N J Mundy, Senior Coroner for South Yorkshire (East District)

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.

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 11/04/2016 | commenced an investigation into the death of Lyndsey Holt, 36 . The
investigation concluded at the end of the inquest on 29 March 2017. The conclusion of the
inquest was Natural Causes. The cause of death was 1a. Shock and haemorrhage due to 1b.
Perforated Gastric Ulcer.

CIRCUMSTANCES OF THE DEATH

Miss Holt was 37 weeks pregnant with her third child. There had been no complications during
that pregnancy save that she had suffered from severe and painful varicose veins. In 2011 Miss
Holt had been prescribed with methadone following a telephone conversation with the
prescribing GP who considered that her reported history included reference to there having
being a lengthy dependence on Codeine and also that she had taken Oxycodone and Tramadol.
Specific details of the frequency of usage and amount taken could not be provided to the court.
The dose of methadone had been significantly reduced during Miss Holt’s second and third
pregnancies. It appeared that as well as methadone, Miss Holt took paracetamol for pain relief of
the varicose veins and when particularly severe, took her partner's Oxycodone medication. On
the 2™ April 2016 Miss Holt collapsed at 18:55 due to a gastric ulcer having perforated and there
being catastrophic bleeding thereafter. She was conveyed by ambulance to the Rotherham
Hospital. On leaving the address a pre-alert was requested from the ambulance crew via
Control but Control failed to pass the pre-alert on to the receiving hospital. Had they done so
clinicians at Rotherham would have been aware of Miss Holt’s impending arrival, likely timing of
arrival and the seriousness of the situation they were about to face. Once Miss Holt arrived at
the A&E Department of the Rotherham Hospital an emergency caesarean section was rapidly
performed, extensive resuscitation measures put in place, she underwent a splenectomy, repair
of a ruptured gastric ulcer and towards the end of her life a hysterectomy in a last ditch effort to
try and save her. The overwhelming coagulopathy she had developed and shutting down of
organs led to her death on the morning of the 3" April 2016 from shock and haemorrhage due to
a perforated gastric ulcer.

Coroner's Court and Office, Doncaster Crown Court, College Road, Doncaster, DN1 3HS
Tel 01302 737135 | Fax 01302 736365

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. —

| have concerns regarding the reliability of the pre-alert system, particularly where Control have
responsibility for activating such an alert and passing on of relevant information, as follows:

(1) Absence of systems to audit the effectiveness and reliability of the pre-alert system.

(2) Alack of knowledge/training of staff in Control to equip them with the skills to undertake
reliable actioning of pre-alert requests, the importance of doing and conveyance of all relevant
clinical information.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you The Chief
Executive, Yorkshire Ambulance Service NHS Foundation Trust 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
24 May 2017. |, 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
a Messrs Browne Jacobson, AVMA and Messrs DAC Beachcroft.
| 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 29 Marc

Signature
Senior Coron

for South Yorkshire (East District)

Coroner's Court and Office, Doncaster Crown Court, College Road, Doncaster, DN1 3HS
Tel 01302 737135 | Fax 01302 736365
Also filed under 2017-0096: Holt-2017-0096.pdf
Ms N J Mundy
Senior Coroner for South Yorkshire (East District)

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: Group Practice Manager And Senior Partner
Dinnington Group Practice, The Medical Centre, New Street, Dinnington $25 2EZ

CORONER

lam Ms Nicola Jane Mundy, Senior Coroner for South Yorkshire (East District)

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.

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 11/04/2016 | commenced an investigation into the death of Lyndsey Holt, 36 . The
investigation concluded at the end of the inquest on 29 March 2017. The conclusion of the
inquest was Natural Causes. The cause of death was 1a. Shock and haemorrhage due to ‘1b.
Perforated Gastric Ulcer.

CIRCUMSTANCES OF THE DEATH

Miss Holt was 37 weeks pregnant with her third child. There had been no complications during
that pregnancy save that she had suffered from severe and painful varicose veins. In 2011 Miss
Holt had been prescribed with methadone following a telephone conversation with the
prescribing GP who considered that her reported history included reference to there having
being a lengthy dependence on Codeine and also that she had taken Oxycodone and Tramadol.
Specific details of the frequency of usage and amount taken could not be provided to the court.
The dose of methadone had been significantly reduced during Miss Holt’s second and third
pregnancies. It appeared that as well as methadone, Miss Holt took paracetamol for pain relief of
the varicose veins and, when particularly severe, took her partner’s Oxycodone medication. On
the 2” April 2016 Miss Holt collapsed at 18:55 due to a gastric ulcer having perforated and there
being catastrophic bleeding thereafter. She was conveyed by ambulance to the Rotherham
Hospital. On leaving the address a pre-alert was requested from the ambulance crew via
Control but Control failed to pass the pre-alert onto the receiving hospital. Had they done so
clinicians at Rotherham would have been aware of Miss Holt’s impending arrival, likely timing of
arrival and the seriousness of the situation they were about to face. Once Miss Holt arrived at
the A&E Department of the Rotherham Hospital an emergency caesarean section was rapidly
performed, extensive resuscitation measures put in place, she underwent a splenectomy, repair
of a ruptured gastric ulcer and towards the end of her life a hysterectomy in a last ditch effort to
try and save her. The overwhelming coagulopathy she had developed and shutting down of
organs led to her death on the morning of the 3° April 2016 from shock and haemorrhage due to
a perforated gastric ulcer.

Coroner's Court and Office, Doncaster Crown Court, College Road, Doncaster, DN1 3HS
Tel 01302 737135 | Fax 01302 736365

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. —

The circumstances in which the methadone was prescribed namely:
(1) Doing so over the telephone with no face to face consultation.
(2) Consequent lack of detail regarding:

2.1 the drugs being taken by Miss Holt

2.2 the frequency with which they were being taken

2.3 the degree if any, of her dependence

2.4 absence of assessment of any psychological issues
(3) Providing a methadone naive patient with a 7 day supply.
(4) Lack of medical review during the initial phase.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you, The Group
Practice Manager And Senior Partner, Dinnington Group Practice 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
24 May 2017. |, 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

ia fm the Chief Coroner and to the following Interested Persons :
Messrs Browne Jacobson, AVMA and Messrs DAC
eachcroft.

lam 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 pyblication of your response by the Chief Coroner.

Signature
Senior Coro’

South Yorkshire (East District)

Coroner's Court and Office, Doncaster Crown Court, College Road, Doncaster, DN1 3HS
Tel 01302 737135 | Fax 01302 736365

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