Prevention of Future Deaths reports · 2017

Penelope Benton

Regulation 28 report to prevent future deaths, reference 2017-0349, written 30 Nov 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report30 Nov 2017
Reference2017-0349
DeceasedPenelope Benton
CoronerZafar Siddique
Coroner areaBlack Country
CategoryMental Health related deaths · Suicide (from 2015)
Organisation namedDudley and Walsall Mental Health Partnership NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS  

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  Dudley and Walsall mental Health Partnership NHS Trust 

1 

CORONER 

I am Zafar Siddique, Senior Coroner, for the coroner area of the Black Country. 

2 

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. 

3 

INVESTIGATION and INQUEST 

On the 20 September 2017, I commenced an investigation into the death of the late Ms 
Penelope Benton. The investigation concluded at the end of the inquest on 31 October 
2017. The conclusion of the inquest was a short narrative conclusion of suicide. 

The cause of death was:   

1a   Tramadol Overdose 

4 

CIRCUMSTANCES OF THE DEATH 

i)  Ms  Benton  had  a  complex  medical  history  including  diagnosed  paranoid 
schizophrenia  and  also  a  history  of  self-harm  including  drugs  overdoses.  
She also had a stoma fitted following an obstruction to her bowel.  This had 
caused significant pain over a number of years.  

ii) 

 On the 22 September 2016 she was admitted to Bushey Field Hospital after 
a relapse and sectioned under S3 Mental Health Act.  She disclosed to her 
care  co-coordinator  on  the  26  September  2016  that  she  had  taken  an 
overdose  of  60  Tramadol tablets  and  that  she  had  had  enough  of  her  pain 
and wanted it to go away.   

iii)  After  making  improvement  she  was  discharged  with  support  in  the 
community on the 18 October 2016.  The discharge note did not record any 
details  of  the  Tramadol  overdose  and  the  GP  continued  to  give  her 
Tramadol medication for pain relief.   

iv)  On  the  12  July  2017,  Ms  Benton  took  a  significant  quantity  of  Tramadol 
tablets  (40.4mg/L)  and  fatalities  have  been  associated  with  concentrations 
of greater than 6 mg/L. 

v)  Sadly, she was pronounced deceased on the same day and the cause of 

death was later confirmed as Tramadol overdose. 

1 

[IL1: PROTECT] 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 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.  Evidence emerged during the inquest that the General Practitioner wasn’t made 
aware of the previous tramadol overdose on the discharge letter from Hospital. 

6 

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.  

1.  You  may  wish  to  consider  urgently  reviewing  the  discharge  process  and 
information shared with primary health services on discharge of patients.    

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 29 January 2018. 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. 

8 

COPIES and PUBLICATION 

I  have  sent  a  copy  of  my  report  to  the  Chief  Coroner  and  to  the  following  Interested 
Persons; Family. 

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. 

9 

 30 November2017                                                   

Mr Zafar Siddique
Senior Coroner 
Black Country Area 

2 

[IL1: PROTECT]

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 Dudley and Walsall NHS Trust (PDF)
2nd Floor Trafalgar House 
47-49 King Street 
Dudley 
DY2 8PS 
Tel: 01384 324524 

Email: 

19/01/2018 2016 

Mr Z Siddique 
HM Senior Coroner 
Black Country Coroner’s Court 
Jack Judge House 
Halesowen Street 
Oldbury 
West Midlands 
B69 2AJ 

Dear Mr Siddique 

Ref: Penelope Benton Regulation 28 Ruling – Dudley and Walsall Mental Health 
Partnership NHS Trust Response 

I am writing on behalf of Dudley and Walsall Mental Health Partnership NHS Trust in 
response to the recent HM Coroners Regulation 28 Report issued to the Trust, following 
the recent coronial inquest into the death of Ms Penelope Benton. 

I would, first of all, like to pass on our sincere condolences and state that the Trust is fully 
committed to providing excellent Mental Health care to the service users of Dudley and 
Walsall in a way which is safe and effective for patients and their families. 

The Trust acknowledges the fact that in this instance the General Practitioner was not 
made aware of the previous tramadol overdose in the discharge letter from hospital.  The 
Trust has agreed standards in relation to ensuring good communication with General 
Practitioners which includes the standards expected when writing discharge letters.  A 
copy of these standards can be found within appendix 2 of this response.  Unfortunately in 
this instance, whilst the discharge letter addressed all the key areas outlined within the 
standard/template, the information contained within the letter was inaccurate in this single 
point and failed to include details of this overdose. 

As a Trust which constantly looks to improve its services and learn lessons from incidents, 
the Trust will conduct a review of its standards around discharge communications and 
reiterate the importance to medical staff that incidents and risk factors are included within 
discharge letters where this is necessary.   

It should also be noted that consultant teams also undertake audits in relation to the 
quality of discharge letters and communication with GPs to ensure / monitor the quality of 
discharge communication and ensure that the standard of these letters remains high.  A 
required frequency / standard of audit and checking will be agreed as part of this review 

 
 
  
 
 
 
 
 
 
 
 
 
 
 
 and will be communicated to medical teams.  A summary of these proposed actions is 
outlined within the enclosed appendix 1. 

I trust that the proposed course of action addresses the areas of concern outlined within 
your regulation 28 report to the Trust however should you have any further concerns 
please do not hesitate to contact us for more information. 

Yours sincerely 

Mark Axcell 
Chief Executive Officer

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