Prevention of Future Deaths reports · 2017

Hannah Barney

Regulation 28 report to prevent future deaths, reference 2017-0442, written 11 Jul 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report11 Jul 2017
Reference2017-0442
DeceasedHannah Barney
CoronerAndrew Harris
Coroner areaLondon Inner (South)
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.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:

1. Professor Julia Wendon, Executive Medical Director, King’s College Hospital,
Denmark Hill, London SE5 9RS

CORONER

Tam Andrew Harris, Senior Coroner, London Inner South jurisdiction

CORONER’S LEGAL POWERS

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

INQUEST

On 17th November 2016, I opened an inquest into the death of Ms Hannah
Barney, who died on 11.10.15 (0270-15) (PF) in Kings College Hospital

It was concluded on 6th June 2017. The medical cause of death was:

1a Multi-organ failure

1b Extensive soft tissue bacterial and fungal infection

ic Haemolysis, Elevated Liver Enzyme and Low Platelets syndrome of pregnancy
causing liver failure and multiple thrombi; multiple broad spectrum antibiotics
II Genetic Prothrombotic tendency

The conclusion as to the death was by narrative which included: “After intensive
medical treatment she was initially referred for surgical debridement of an infected
groin haematoma on 11th, which was conducted on 16th and more urgently on
18th, she developed multi-organ failure...”

CIRCUMSTANCES OF THE DEATH
The evidence of Prof Heneghan was:

Between the 11th and 18th September she was acutely ill and required many
specialist opinions and multi-disciplinary care. The tissue viability nurse
considered urgent surgical opinion was needed on management of her infected
wound. She saw a hepatologist and nephrologist on 12th, a weekend surgical team
on call on 13th, the renal team on 15th and a hepatobiliary surgeon in theatre on
16th. The case was then discussed with a plastic surgery registrar, who suggested
that an urgent full debridement should be undertaken but this could not be done
at King’s College Hospital since there was no on-call plastic cover, and would
ultimately need to be performed at St Thomas Hospital. A gynaecology registrar
attended on 17th. A scan was performed to exclude necrotising fasciitis and

it was agreed that the general surgical consultant would take her to theatre. It was
not until 18th when a multi-disciplinary team of gynaecologist, plastics, general
surgery and orthopaedics back up was assembled and surgical debridement was
performed but she died later in ITU.

CORONER’S CONCERNS

During the course of the inquest, the evidence revealed a matter giving rise to
concern that in my opinion means that there is still a risk that future deaths will
occur unless action is taken. In the circumstances it is my statutory duty to report
to you.

The MATTER OF CONCERN is as follows. -

The plastics surgical consultant who saw her on 18th and 21st gave
an opinion that she had haematomas and severe sepsis, although the diagnoses of
Fournier’s gangrene or necrotising fasciitis had been considered. These conditions
needed very urgent surgical treatment. He said that a few days delay in
debridement could make a difference to the damage to surrounding tissues. .
General surgeons are often reluctant to undertake such debridements and may not
have the skills. He opined that having a sole consultant plastics surgeon
practitioner in KCH was not safe. In cases of necrotizing fasciitis a small delay in
surgery would mean death. He noted that KCH was a regional trauma centre. He
considered future lives were at risk without a 24 hour consultant plastics service at
KCH.

ACTION SHOULD BE TAKEN

I send this report to KCH to draw your attention to this reported risk and copy it
to NHS England and the Department of Health, as I believe that these bodies are
in apposition to take action.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by Monday, September 4* 2017. 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.

If you require any further information or assistance about the case, please contact
the case fier, Imma

COPIES and PUBLICATION

[have sent a copy of my report to the following Interested Persons:

ES (2h)

Tam also sending this report to the following, who may have an interest:

Department of Health
NHS England

Royal College of Surgeons
St Thomas Hospital

Tam 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.

[DATE] [SIGNED BY CORO J
yh My 2017 ye

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