Prevention of Future Deaths reports · 2017

Michael Newell

Regulation 28 report to prevent future deaths, reference 2017-0123, written 13 Apr 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report13 Apr 2017
Reference2017-0123
DeceasedMichael Newell
CoronerJames Adeley
Coroner areaPreston and West Lancashire
CategoryHospital Death (Clinical Procedures and medical management) related deaths
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.

for PRESTON AND WEST LANCASHIRE

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT 10: EE Medica Dir Lancashire Teaching
Hospitals NHS Trust

CORONER

tam Dr James Adeley, Her Majesty's Coroner for PRESTON AND WEST LANCASHIRE
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.qov.uk/ukpga/2009/25/schedule/5/paragraph/7
http://www. legislation.gov.uk/uksi/2013/1629/part/7/made

INVESTIGATION and INQUEST

On 4 April 2017 | commenced an investigation into the death of Michael John NEWELL aged
70. The investigation concluded at the end of the inquest on 11 April 2017. The conclusion of the
inquest was as set out in the attached summing up on the last page.

CIRCUMSTANCES OF THE DEATH

The full circumstances of the death set out in chronological order together with a summary of the
expert evidence is attached in my summing up. The Trust already has a complete copy set of the
medical records and particular reference should be paid to the clinical entries made whilst
Michael Newell was on the Neurosurgical ward on 4-5 May 2014, the fluid prescription charts,
the fluid balance charts and the TPR chart.

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) the Accident & Emergency staff, neurosurgeons and ENT surgeons of various grades were
unaware of the substantial effect that Mr Newell's decompensated liver failure would have on his
clinical course and subsequent management. No input was sought from any medical team to
assist in the management prior to Mr Newell's first collapse at 11:14 AM on 5 May 2014. This
lack of awareness raises significant concerns about the knowledge base of Accident &
Emergency and surgical junior staff of the significant effect of substantial underlying hepatic
compromise may have on any form of admission with some form of haemorrhage. As a result,
the family were completely unaware of the significance of Mr Newell's admission due to the lack
of awareness by attending clinicians.

(2) the junior ENT surgeons and neurosurgeons showed a startling lack of knowledge of the
early signs of hypovolaemia and, if any did realise, made no attempt to treat Mr Newell
adequately. Whilst this PFD report is primarily sent with regard to the death of Mr Newell, this
has been a feature over a number of years of other cases where hypovolaemia was not
appropriately diagnosed and late resuscitation ensued.

(3) there was a worrying lack by the ENT surgeons to realise the complexity of the case due to
the ongoing haemorrhage, decompensated liver failure and associated coagulopathy, that there

Coroner's Court, 2 Faraday Court, Faraday Drive, Fulwood, Preston, Lancashire, PR2 9NB
Tel 01772 703700 | Fax 01772 704422

were no base of skull fractures and to select a method of treatment with Rapid Rhino Pack's that
in the view of the ENT expert was only appropriate as a first-line measure and not for facial
fractures. Firstly, there was no consultant ENT input into Mr Newell's case at any point prior to
his death. Secondly, none of the above issues were brought to the attention of the Court in the
ENT consultant's statement raising issues within the Trust for improving patient care.

(4) the Trust's ENT team made no input into the mortality review prior to it reaching its
conclusions. Alternatively, the mortality review team made no request for ENT input prior to
reaching its conclusions. Either formulation reduces the effectiveness of the mortality review.

(5) the conduct of the Nurse in charge of the ward of making no notes after her presence at a
peri-arrest, neither seeking or obtaining any direction from the medical team as to future
management, not directing any further resuscitation in accordance with documented medical
plans in the notes and lack of completion of the fluid balance chart would suggest that the Trust's
procedures for determining which nurse clinicians may lead a nursing shift should be reviewed.

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
(DATE). |, 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
t have sent a copy of my report to the Chief Coroner and to the Family.
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 gpresentations. to me, the coroner, at the time of your response, about the

Coroner's Court, 2 Faraday Court, Faraday Drive, Fulwood, Preston, Lancashire, PR2 9NB
Tel 01772 703700 | Fax 02772 704422

Related reports

Other reports by James Adeley

See all →

More reports categorised “Hospital Death (Clinical Procedures and medical management) related deaths”

See all →

Track Hospital Death (Clinical Procedures and medical management) related deaths

See every Prevention of Future Deaths report matching Hospital Death (Clinical Procedures and medical management) related deaths, and how often a new one appears.

What would an alert for this have sent me? Search the full text

Free to try — the preview shows the real matches and how many arrived in the last 12 months. Your first email alert is free.

These reports are published by the Chief Coroner's office at judiciary.uk and are © Crown copyright. The text here is reproduced from the published PDF so it can be searched. If something on this page is wrong, or you are a person named in it and want it reviewed, email drcjar@gmail.com and we will act promptly.