Prevention of Future Deaths reports · 2018

Howard Winter

Regulation 28 report to prevent future deaths, reference 2018-0040, written 8 Feb 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report8 Feb 2018
Reference2018-0040
DeceasedHoward Winter
CoronerGraeme Hughes
Coroner areaSouth Wales Central
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

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.

ANNEX A

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This form is to be used after an inquest.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

1. Chief Executive of Cwm Taff University Health Board

CORONER

| am Graeme Hughes, Assistant Coroner, for the coroner area of South Wales Central
Area.

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.

INVESTIGATION and INQUEST

On the 21* September 2017 | commenced an investigation into the death of Howard
Winter aged 85. The investigation concluded at the end of an inquest on 1* February
2018. The medical cause of death was 1a. Hospital Acquired Pneumonia, 1b C5-6
vertebral fracture with cord injury, alongside subdural bleeding in the setting of a person
with ankylosing spondylitis, 1¢ Recurrent Falls & 2. Vascular Dementia. The conclusion
of the inquest was Accidental Death.
CIRCUMSTANCES OF THE DEATH

The deceased was a resident at the Daffodils CH, Merthyr Tydfil. He suffered from
vascular dementia & had frequent falls. On 23.8.17 he fell in his room, sustained a
serious head injury & was taken to PCH, Merthyr Tydfil. On 11.9.17 he was diagnosed
with a fractured spine. He developed pneumonia & died there on 16.9.17

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. —

When Mr Winter attended at A & E on 23 & 26.8.17, he was diagnosed with a subdural
haematoma following a CT scan head. It was not until after a CT scan of his spine was
undertaken on 11.9.17 that he was diagnosed with a cervical spine fracture. The
question arose as to whether, & following his initial presentation on 23.9.17 & admission
on 26.8.17 there was any evidence of symptoms of neck pain which could have given
rise to earlier investigations into, & possible earlier diagnosis of the cervical spine
fracture.
ae o- evidence at the Inquest that on the 26.8.17 an auxiliary nurse had
recorded in the nursing notes — “pain in neck/back — unable to score”. There was no
evidence — written or otherwise, to demonstrate an escalation of this finding to a doctor

for re-assessment, investigation & diagnosis.

levidence to the Inquest was that this ought to have occurred.

Whilst this apparent absence of escalation may not necessarily have affected the

outcome for Mr Winter, were it to be repeated now, or in the future, the outcome for the
patient involved could be potentially causative of/contribute towards death/adverse i
outcome.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you and your
organisation 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 5" March 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.

COPIES and PUBLICATION

| have sent a copy of my report to the Chief Coroner, the family and the Minister of
Health Welsh Government Assembly who may find it useful or of interest.

| 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 re: e by the Chief Coroner.

8" February 2018 SIGNED:

N

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 University Health Board (PDF)
Your Ref/eich cyf:

Our Ref/ein cyf: KA/LB
4 GIG | swrdd techyd Prifysgol Date/dydaiad: 19" March 2018
Gr Cwm Taf Tel/ffén: 01443 744921
N HS Fax/FFacs: 01443 744889
University Health Board Email/ebost: Kamal.asaad@wales.nhs.uk
Dept/adran: Executive

Private & Confidential

Mr AR Barkley

Senior Coroner for South Wales Central
Rock Grounds

First Floor

Aberdare

CF44 7AE

Dear Mr Barkley
RE: Regulation 28 for Howard Winter

Thank you for the correspondance in relation to the above Regulation 28 received on 14" February
2018, which was also sent to the Health Board CEO Mrs Allison Williams. Please note that I have
discussed the content of your letter with both the CEO and the Director of Nursing.

In relation to improvement work being undertaken within Cwm Taf University Health Board regarding
NEWS I wish to assure you that the following work has taken place:

1. Two audits have been undertaken across the Health Board to measure how the NEWS scores
are completed and escalated.

2. We have a University Health Board Clinical Lead for the RRAILS (Rapid Response to Acute illness
Learning Set) who is a Consultant Anaesthetist and also the National Lead overseeing this
important piece of work.

The audit has identified the need for further education and training as well as raising awareness
amongst nursing and medical staff in relation to accurate documentation and escalation. The audit
has also identified priority clinical areas for improvement work which will be progressed.

Monitoring of the improvement work is undertaken via the quarterly quality report to the Quality &
Risk Safety Committee.

I hope that I have provided assurance to you that your concerns are being dealt with in the University
Health Board as part of our ongoing Quality Delivery Plan.

Kind Regards ZU MAR 2018

Return Address: Cwm Taf University Health Board, Headquarters, Navigatio
4SN

Chair / Cadeirydd; Professor Marcus Longley Chief Executive / Prif Weithredydd: Mrs A Williams

Cwm Taf University Health Board is the operational name of the Cwm Taf University Health Board/Bwrdd lechyd Prifysgol Cwm Taf yw enw gwelthredo!
Bwrdd lechyd Prifysgol Cwm Taf

Vownal Asan.

Mr Kamal Asaad
Medical Director
Cwm Taf University Health Board

Cc. Mrs Allison Williams, CEO, Cwm Taf UHB
Mrs Lynda Williams, Director of Nursing & Midwifery Services, Cwm Taf UHB

Return Address: Cwm Taf University Health Board, Headquarters, Navigation Park, Abercynon, CF4!
4SN :

Chair / Cadeirydd; Professor Marcus Longley Chief Executive / Prif Weithredydd: Mrs A Williams

Cwm Taf University Health Board is the operational name of the Cwm Taf University Health Board/Bwrdd lechyd Prifysgol Cwm Taf yw enw gweithredo!
Bwrdd lechyd Prifysgol Cwm Taf

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