Prevention of Future Deaths reports · 2018

Dylan Hill

Regulation 28 report to prevent future deaths, reference 2018-0004, written 4 Jan 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report4 Jan 2018
Reference2018-0004
DeceasedDylan Hill
CoronerTanyka Rawden
Coroner areaSouth Yorkshire (West)
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Other related deaths
Sourcejudiciary.uk record · original PDF
Responses published3

The report

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

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS  

1 

2 

3 

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

1.  Secretary of State for Health, Richmond House, 79 Whitehall, London, 

SW1A 2NS 

2.  Food Standards Agency, Aviation House, 125 Kingsway, London, WC2B 

6NH 

CORONER 
Tanyka Rawden, Assistant Coroner for South Yorkshire (West) 

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.  

INVESTIGATION 

On 28 July 2015 an investigation was commenced into the death of Dylan Paul Hill aged 
18  years.    Following  a  post-mortem  examination,  the  investigation  concluded  with  an 
inquest on 19 and 20 December 2017. 

The  inquest  was  assisted  with  evidence  from  the  partner  of  Dylan  Hill  who  was  at  the 
restaurant  with  him,  representatives  from  Trading  Standards  and  Environmental  Heath, 
the owner of the restaurant and an expert, 

. 

The conclusion of the inquest was that Dylan Paul Hill died at Barnsley General Hospital 
of  an  anaphylactic  reaction  after  eating  a  korma  meal  at  a  restaurant  in  Barnsley  on 
17.05.15.  Dylan was served a korma containing almond powder.  That powder contained 
almonds  and  peanuts.    The  restaurant  was  not  aware  the  almond  powder  contained 
peanuts  as  it  was  not  labelled  and  had  been  decanted  into  another  container. 
Importantly, no steps had been taken by the restaurant to ascertain the ingredients of the 
almond powder. 

There was no allergen information on the menus or displayed in the restaurant  

Dylan  didn’t  have  his  EpiPen  with  him  but  it  cannot  be  said  this  would  have  brought 
about a different outcome. 

 
 
 
 
 
 
 
 4 

CIRCUMSTANCES OF THE DEATH 

Dylan Paul Hill was diagnosed with a peanut allergy at the age of ten.  In consequence 
he had been issued with an adrenaline auto-injector (in this case an EpiPen). Mr Hill also 
suffered from asthma. 

On 17.05.17 Mr Hill and his partner went to a restaurant in Barnsley.  Mr Hill ordered a 
Korma meal and became unwell after eating one or two mouthfuls. 

He asked the waiter whether the meal contained nuts and was told it did.  

After  returning  home  a  short  time  later  Mr  Hill  collapsed  and  was  confirmed  dead  on 
arrival at the local A&E Department.  

Pathology examination showed that Mr Hill had died of an anaphylactic reaction. 

Examination  of  the  contents  of  the  ingredients  of  the  korma  showed  that  the  ‘almond 
powder’  contained  94%  almonds  and  6%  peanuts.    In  evidence  it  was  clear  the 
restaurant  did  not  know  the  ‘almond  powder’  contained  peanuts  as  the  ingredients  had 
not  been  checked  on  purchase,  the  powder  had  been  decanted  into  an  unlabeled 
container, and the packaging disposed of.   

5 

CORONER’S CONCERN 

During the course of the investigation my inquiries 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 MATTER OF CONCERN is as follows.  –  

Evidence  was  given  before  the  Court  of  an  incident  within  the  same  premises  in 
September  2014  where  a  curry  containing  nuts  was  given  to  a  customer  who  had 
requested a nut free curry.  That customer had an anaphylactic reaction and was taken 
to hospital where he made a full recovery. 

Evidence was also given that the Trading Standards department of the local council had 
not  been  told  of this incident  prior  to the  death  of  Mr Hill.   Had they  known,  they  would 
have arranged a priority visit. 

After  Mr  Hill's  death  the  restaurant  were  issued  a  prohibition  notice  that  they  were  not 
permitted to offer allergen free meals. 

Evidence  was  given  that  there  are  no  procedures  in  place  for  such  communications 
between  the  health  services  and  Trading  Standards  in  cases  of  non  fatal  anaphylactic 
reactions. 

In  my  opinion  there  is  a  risk  that  future  deaths  may  occur  unless  cases  of  non  fatal 
anaphylactic  reactions  caused  by  the  ingestion  of  purchases  from  food  business 
operatives  are  reported  to  those  regulatory  authorities  responsible  for  the  supervision 
and monitoring of food safety and hygiene.  

The question therefore arises as to whether the emergency services and health services 
within  the  area  can  work  together  to  ensure  that  Trading  Standards  Departments  are 
made  aware  of  all  anaphylaxis  incidents  relating  to  commercial  premises  so  that  the 
appropriate action can be taken as regards those premises. 

 
 
 
 
 
 
 
 
 
 
 
 
 6 

ACTION SHOULD BE TAKEN 

In my opinion urgent action should be taken to prevent future deaths and I believe 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 1 March 2018. I may extend this period upon your application. 

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 
Person: 

, family representative. 

Others sent copies for information: 

1.  Chief Executive, Sheffield Teaching Hospitals NHS Foundation Trust 
2.  Chief Executive, Sheffield Children’s hospital, Sheffield, Western Bank, Sheffield, 

S10 2TH 

3.  Chief Executive, Barnsley District Hospital, Gawber Road, Barnsley, S75 2EP 
4.  Chief Executive, Clinical Commissioning Group, Sheffield, 722 Prince of Wales 

Road, Sheffield, S9 4EU 

5.  Chief Executive, Clinical Commissioning Group, Barnsley, 49/51 Gawber Road, 

Barnsley S75 2PY 

6.  Chief Executive, Yorkshire Ambulance Service, Springhill 2, Wakefield 41 

Business Park, Brindley Way, Wakefield, WF2 0XQ 

7.  Chief Executive, Trading Standards, Sheffield City Council, 5th Floor, Howden 

House, Sheffield, S1 2SH 

8.  Chief Executive, Trading Standards, PO Box 602, Barnsley, S70 9FB 
9.  Environmental Health, Sheffield City Council, Staniforth Road, Sheffield, S9 3HD 
10.  Environmental Health, Barnsley Metropolitan Borough Council, Common Road, 

Brierley, Barnsley, S72 9EP 

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. 

Mrs Tanyka Rawden                                                                                                                          
4 January 2018

Responses

3 responses 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 Barnsley Hospital NHS Trust (PDF)
) :
ia Barnsley Hospital .
@ = las ab
as Quality in Care Barnsley Hospital [Vij
NHS Foundation Trust
Gawber Road

| Barnsley
$75 2EP

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} : ; Tel: 01226 730000
Fax: 01226 202859
Minicom: 01226 321014

MrsTanyka Rawden
Assistant Coroner

The Office of H.M Coroner
The Medio-Legal Centre
Watery Street

Sheffield

S3 7ET

5 March 2018
Our ref: RJ/KR

Dear Mrs Rawden
Re: Dylan Paul Hill (Deceased)

May | thank you for including our Trust in the circulation list for the Regulation 28 that you issued on 5
January 2018, and forwarded to Secretary of State for Health and Food Standards Agency.

Whilst the Regulation 28 does not require a formal response from our Trust we have taken a decision
to respond to the points that you have raised to improve working relationships between the Trust
Trading Standards at Barnsley Metropolitan Council to improve the safety and care of people in the
Barnsley locality.

The purpose of my letter is to inform you that Barnsley Hospital NHS Foundation Trust has taken the
following action to address the Coroner’s concerns that were provided in your letter (dated 5 January
2018) and can be responded to as follows:

Evidence was also given that the Trading Standards department if the local council had not
been told of this incident prior to the death of Mr Hill. Had they known, they would have
arranged a priority visit.

Our anaphylaxis draft protocol has been reviewed and updated in accordance with our internal
governance processes (see enclosure 1).

Evidence was given that there are no procedures in place for such communications between
the health services and Trading Standards in cases of non fatal anaphylactic reactions.

Our revised anaphylaxis draft protocol includes a referral form to inform Trading Standards of cases
of anaphylactic reaction as a result of consuming food from commercial premises.

In my opinion there is a risk that future deaths may occur unless cases of non fatal
anaphylactic reactions caused by the ingestion of purchases from food business operatives
are reported to those regulatory authorities responsible for the supervision and monitoring of
food safety and hygiene.

The enclosed protocol has a clear algorithm on medicine management and how the detail of the
consumption at the commercial premises is communicated to the local authority to ensure the timely
communication of potential risks.

jg ee ee ee en ae
www.barnsleyhospital.nhs.uk — (<) @barnshospital —[}_ www.facebook.com/barnsleyhospital

The question therefore arises as to whether the emergency services and the health services
within the area can work together to ensure that Trading Standards Departments are made
aware of all anaphylaxis incidents relating to commercial premises so that the appropriate
action can be taken as regards these premises.

Our enclosed draft protocol has been circulated with the listed interested parties named in this
Regulation 28 letter.

The draft protocol will be taken to the Trust’s Clinical Business Unit Governance Meeting on 23 March
2018 for it to be reviewed and ratified we will forward you the final protocol when this has been
agreed.

Yours sincerely
VAD,

Dr Richard Jenkins
Chief Executive

Enclosure: Barnsley Hospital NHS Foundation Trust’s Anaphylaxis (Draft Protocol)

Copy to:

Chief Executive, Sheffield Teaching Hospitals NHS Foundation Trust

Chief Executive, Sheffield Children’s Hospital, Sheffield, Western Bank, Sheffield $10 2TH

Chief Executive, Clinical Commissioning Group, Sheffield, 772 Prince of Wales Road, Sheffield S9 4EU

Chief Executive, Clinical Commissioning Group, Barnsley, 49/51 Gawber Road, Barnsley S75 2PY

Chief Executive, Yorkshire Ambulance Service, Springhill 2, Wakefield, 41 Business Park, Brindley Way,
Wakefield WF2 0XQ

Chief Executive, Trading Standards, Sheffield City Council, 5" floor, Howden House, Sheffield $1 2SH

Chief Executive, Trading Standards, PO Box 602, Barnsley S70 9FB

Environmental Health, Sheffield City Council, Staniforth Road, Sheffield S9 3HD

Environmental Health, Barnsley Metropolitan Borough Council, Common Road, Brierley, Barnsley S72 9EP

Page 2 of 2
Response from Department of Health (PDF)
BGR From Steve Brine MP

rE Parliamentary Under Secretary of State for Public Health and Primary Care
Department

of Health , ; 39 Victoria Street

London

SW1H OEU

020 7210 4850

PFD-1113293 lV, Cees

Mrs Tanyka Rawden 88 MAR 2919
HM Assistant Coroner, South Yorkshire (West)

Office of HM Coroner

The Medico-Legal Centre

Watery Street

Sheffield S3 7ET

poe Mr fawber,

hank you for your letter of 5 January to the Secretary of State about the death of
Mr Dylan Paul Hill. I am responding as Minister with responsibility for public
health.

I was extremely saddened to read of the circumstances surrounding Mr Hill’s death.
Please pass my condolences to his family and loved ones. I can only imagine how
difficult a time this must be for them.

Your Report raises the concern that future deaths might occur unless cases of
non-fatal anaphylaxis brought on by the ingestion of food consumed from
commercial premises are reported to the relevant regulatory authorities overseeing
food safety and hygiene.

My officials have made enquiries with the Food Standards Agency (FSA), to which
you also issued your Report, and I understand the Agency shares your concerns. The
FSA wishes to set up a cross-government discussion to consider this matter further. I
hope this will be a welcome development and will provide assurance that the matter
will be considered carefully. I am advised that the FSA will update you on the
outcome of discussions in due course.

At a local level, I am advised that Barnsley and Sheffield are working to explore the
development of local notification systems in both primary and secondary care
settings. This includes collaborative working between Barnsley and Sheffield acute
trusts to ensure there is consistency in the mechanisms being put in place, as well as
consideration of the best way to raise awareness among GPs. This issue and the

progress made on measures to address it will be monitored by the Sheffield and the
Barnsley Health Protection Boards.

The local NHS is mindful of any action that might be taken at a national level and
clearly any developments will inform future local action. However, I hope you are
assured the local NHS is working to explore what measures can be put in place at a
local level.

I hope this response is helpful. Thank you for bringing the circumstances of Mr
Hill’s death to our attention.
Response from Food Standards Agency (PDF)
» Food From Jason Feeney CBE
Standards Chief Executive

~ Agency

Mrs Tanyka Rawden

HM Assistant Coroner, South Yorkshire (West)

Office of HM Coroner |

The Medico-Legal Centre |
Watery Street Fare
Sheffield —
$3 7ET

Date: 28 February 2018 Our Ref: BC2018/0013
Dear Mrs Rawden,

Thank you for sending the Regulation 28: Report to Prevent Future Deaths to the Food
Standards Agency, following an investigation into the death of Mr Dylan Paul Hill, which
concluded with an inquest on 19 and 20 December 2017. .

| am saddened to hear about the death of Mr Hill, and my thoughts are with his friends and
family. We are aware that the Department of Health and Social Care will be responding to
you regarding measures to be put in place at a local level.

In March, we will be meeting with representatives from other government departments
(including the Department of Health and Social Care and Public Health England) and
organisations involved in food allergy to discuss how we can better tackle the issue. We
would, of course, welcome your contribution if you wouid like to take part in such
discussions. Alternatively, we will keep you in touch with developments on this issue.

On raising awareness about food allergy, we provided stakeholders with key messaging
before and after the allergen information and labelling rules became enforceable in
December 2014. These have been particularly around the changes in legislation, detailing
the obligations and responsibilities of the business, but also to let consumers know how to
look for allergen information.

In relation to enforcement of allergens information and labelling rules, we have provided
clarification in the Food Law Code of Practice and associated Practice Guidance,
implemented in 2017, and are looking to further strengthen these documents to address
allergen management and cross contamination issues. Later this year, we will be placing

Floors 6 & 7, Clive House A Ss
70 Petty France, London SW1H 9EX Wis

food.gov.uk/ratings

more emphasis on reporting of near misses and deaths from food allergy in the Practice
Guidance. We will also be writing to local authorities to highlight lessons learnt, and
reinforce our expectations on good allergen management practices.

Food allergy remains one of the FSA's priority areas and we will continue to focus our efforts
to help consumers make informed food choices, to help businesses to understand and
comply with legislation relating to allergen information and labelling. Chun-Han Chan, who
leads in the Food Allergy & Intolerance Branch on Allergen Legislation and Risk
Assessment, will be organising the cross-Government discussions. | would be grateful if you
could contact her (chun-han.chan@food.gov.uk) if you wish to be involved in the
discussions.

Yours sincerely,

Jason Feeney CBE

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