Prevention of Future Deaths reports · 2017

John Scallan

Regulation 28 report to prevent future deaths, reference 2017-0391, written 13 Nov 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report13 Nov 2017
Reference2017-0391
DeceasedJohn Scallan
CoronerBina Patel
Coroner areaCoventry
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedCoventry and Warwickshire Partnership NHS Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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

Regulation 28:  Prevention of Future Deaths report 

THIS REPORT IS BEING SENT TO: 

 Chief Executive, Coventry & Warwickshire Partnership NHS Trust 

1 

CORONER 

I am Bina Patel, Assistant Coroner for the area of Coventry. 

2 

CORONER’S LEGAL POWERS 

I make this report under the Coroners and Justice Act 2009, paragraph 7, 
Schedule 5, and The Coroners (Investigations) Regulations 2013, 
regulations 28 and 29. 

3 

INVESTIGATION and INQUEST 

On  the  7th  day  of  June  2016  my  Senior  Coroner,  Sean  McGovern, 
commenced an investigation into the death of John James Leo Scallan. I 
concluded the investigation by way of a two day inquest on the 1st day of 
November 2017. 

 The medical cause of death was 1a Respiratory depression from sedative 
drugs codeine, morphine and zopiclone.  

 My  Conclusion  was  a  narrative:  Mr  Scallan  was  prescribed  the  drugs 
found  in  his  body  post-mortem  but  the  levels  of  codeine,  morphine  and 
zopiclone exceeded those actually prescribed.  

4 

CIRCUMSTANCES OF THE DEATH 

Mr Scallan was admitted to University Hospital Coventry & Warwickshire 
on  the  24th  day  of  May  2016  after  sustaining  injuries  as  a  result  of  an 
alleged assault. During his admission he underwent an operation to fix a 
fracture of the mandible.  

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
 On the 27th May 2016 following an outburst on the ward Mr Scallan left   
the  ward  and  on  his  return  and  on  the  advice  of  a  Consultant 
Psychiatrist,  he  was  transferred  to  the  Hearsall  Ward  at  the  Caludon 
Centre  on  the  28th  May  2016  as  an  informal  patient  where  he  was 
placed  on  Level  2  –  intermittent  observations  otherwise  known  as  15 
minute observations. 

On  the  29th  May  2016  at  12:25  hours  in  his  bedroom  at  the  Caludon 
Centre, he was found to be unresponsive following a cardiac arrest.  

During  his  admissions  he  was  prescribed  and  administered  drugs; 
however, the levels found in his blood after death were in excess to that 
prescribed.  

There  was  no  explanation  as  to  how  this  occurred.  No  concerns 
regarding his condition had been raised by those observing him. 

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. 

During  the  inquest  the  court  heard  evidence  from 

, Consultant Physician and Clinical Pharmacologist. He highlighted 
the  inconsistences  in  the  observation  chart  from  Hearsall  ward  and  the 
statements from the staff that compiled it.  

The  Observation  Chart  also  implied  protocol  that  required  staff  to  enter 
the room of patients who had not moved since the last check i.e. “that if 
the  patient  is  asleep  and  not  moved  since  the  last  check  welfare  is 
assessed and recorded”. There was no record of this having happened, 
despite runs of readings by different observers that indicated Mr Scallan 
was in the same position on consecutive observations. 

Professor Ferner’s evidence was that the observations undertaken would 
not  have  sufficed  to detect deterioration  in the  clinical  state  of  a  patient 
who was poisoned with sedative drugs.  

The  NHS  Coventry  &  Warwickshire  Partnership  Trust  Observation  and 
Engagement Policy states the checks should be seen in terms of positive 
engagement with the patient and involve, whenever possible, interaction 
and positive contact with the patient.  

  
  
  
  
  
  
  
  
  
  
  
  
 
  
  
  
  
  
 The MATTERS OF CONCERN are as follows:  

1.  1. The adequacy and reliability of the intermittent observations.  

2.  2.  The  Observation  and  Engagement  Policy  indicates  checks  should 
be seen in terms of positive engagement with the patient and involve, 
whenever  possible,  interaction  and  positive  contact  with  the  patient 
and sighting the patient from a distance and recording whereabouts is 
not acceptable intermittent observation.  

The  evidence  from  the  front-line  health  care  assistants  showed  little 
insight  into  the  requirements  of  intermittent  observations  as  well  as 
awareness  of  the  new  observation  sheets  and  how  these  should  be 
completed in line with the policy.  

There  was  a  clear  reluctance  by  members  of  staff  to  enter  a  patient’s 
room  to  conduct  observations  in  particular,  when  the  patient  was 
sleeping in the middle of the day.  

6 

ACTION SHOULD BE TAKEN 

In  my  opinion  action  should  be  taken  to  prevent  future  deaths  and 
I believe that you have the power to take such action. 

7 

YOUR RESPONSE 

You  are  under  a  duty  to  respond  to  this  report  within  56  days  of  the 
date  of  this  report,  namely  by  8th  January  2018.  I,  the  coroner,  may 
extend the period. 

Your  response  must  contain  details  of  action  taken  or  proposed  to  be 
timetable  for  action.  Otherwise  you  must 
taken,  setting  out 
explain why no action is proposed. 

the 

  8 

COPIES and PUBLICATION 

I have sent a copy of my report to the following. 




the Chief Coroner of England & Wales 

, Father of John James Leo Scallan 

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 

13th November 2017 

Bina Patel  
Assistant Coroner for the area of Coventry

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