Prevention of Future Deaths reports · 2018

Robert Wrinch

Regulation 28 report to prevent future deaths, reference 2018-0244, written 25 Jul 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report25 Jul 2018
Reference2018-0244
DeceasedRobert Wrinch
CoronerAlison Mutch
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedStockport NHS Foundation Trust
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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT |S BEING SENT TO: The Chief Executive of Stockport
NHS Foundation Trust, Greater Manchester Strategic Health Group,
Royal College of Pathologists, Secretary of State for Health.

CORONER

lam Alison Mutch, Senior Coroner, for the Coroner area of South
Manchester

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 7" April 2017, | commenced an investigation into the death of Robert
Thomas Wrinch. The investigation concluded on the 21®' June 2018 and
the conclusion was one of Narrative: Died from the recognised
complications of an undiagnosed metastatic spinal malignancy.

The medical cause of death was; 1a) Bronchopneumonia;1b) Metastatic
spinal malignancy (undifferentiated carcinoma); and Il) Ischaemic heart
disease

Robert Thomas Wrinch lost a significant amount of weight in 2016 and
was in significant pain in his back. On 19" January 2017, it was identified
that there was strong suspicion of malignancy in T10 and T11 of the
vertebrae. A biopsy took place on 6" February 2017. Robert Thomas
Wrinch continued to deteriorate, his pain increased and his mobility
decreased. He was readmitted to Stepping Hill Hospital where he
continued to deteriorate. He developed pneumonia as a consequence of
his immobility. His biopsy results from 6"" February 2017 were awaited at
the time of his death. Post mortem examination showed that he had stage
4 undifferentiated spinal cell malignancies at T10 and T11 of his
vertebrae. This was the cause of the chronic back pain and consequential
loss of mobility.

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. The Inquest heard evidence that the pathology department at the
Trust had no system for tracking samples. As a result, it was
unclear when samples had been received and analysis had taken
place. There was no documentation of conversations with other
clinicians and so, it was difficult to be clear about the chronology of
events. Transmission dates of the sample to another Trust were
unclear. It was also difficult to know on what date the report of the
pathologists findings had been issued to the treating clinician. It
was unclear if these issues are specific to the pathology
department of the Trust or more widespread.

. The Trust had a system of issuing reports digitally to clinicians to
speed up receipt. In addition the Inquest were told that due to
preferences of clinicians paper copies were also produced and
sent via internal mail to the treating clinicians. The Inquest heard
that the responsible orthopaedic consultant relied on wholly on the
paper system although this built in delay.

. At the Trust, some departments such as the respiratory
department had clear tracking systems to identify outstanding
pathology reports. Other departments such as orthopaedics did
not. As a result, clinicians could not readily identify where there
was delay in receipt of information required to assess and
diagnose a patient.

. The I.T systems of the pathology department of the Trust and
other hospital Trusts were incompatible with each other. This
meant that transfer of information between trusts to obtain a
second opinion were more difficult.

. The Inquest heard that the delay in analysis of the sample taken
was due to a backlog. The backlog was not unique to the Trust
and such backlogs were prevalent across pathology departments
nationally due to a local and national shortage of pathologists.

ACTION SHOULD BE TAKEN

In my opinion, action should be taken to prevent future deaths and |
believe you 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 19"’ September 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 and to the following
Interested Persons namely EEN wife of the deceased, 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 response by the Chief Coroner.

Alison Mutch OBE
HM Senior Coroner
25.07.2018

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