Prevention of Future Deaths reports · 2018

Joseph Grantham

Regulation 28 report to prevent future deaths, reference 2018-0322, written 18 Oct 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report18 Oct 2018
Reference2018-0322
DeceasedJoseph Grantham
CoronerAlison Mutch
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Child Death (from 2015)
Organisation namedManchester University 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 IS BEING SENT TO: Secretary of State for Health, Chief
Executive of Manchester University NHS Foundation Trust (Royal
Manchester Children's Hospital, St Mary's Hospital), Chief Investigating
Officer of Health and Safety Investigation Branch

CORONER

| am Alison Mutch, Senior Coroner, for the Coroner area of South
Manchester

2 | 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

[3 | INVESTIGATION and INQUEST ]
On10th day of July 2017 | commenced an investigation into the death of
Joseph James GRANTHAM.

The inquest concluded on the 31% August 2018 and the conclusion was
one of Natural Causes.

The medical cause of death was 1a) Sudden and unexpected death of
unknown cause on a background of neural tube defect (cervical
meningocele, hydrocephalus, Arnold Chiari type II malformation)
and laryngomalacia.

4 T CIRCUMSTANCES OF THE DEATH

Joseph James Grantham was born on 9th March 2017 with a neural tube
defect. In addition he developed laryngomalacia. He developed stridor. It
was decided by specialists at Royal Manchester Children's Hospital that
he should be operated on for his neural defect and laryngomalacia.

On 9th July 2017 whilst at church, it was noted he had become
unresponsive. He was taken to Tameside General Hospital where efforts
to resuscitate him were unsuccessful.

After his death, a post mortem found no cause of death; however his
death was attributable to natural causes.

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. After his birth Joseph was transferred to the neonatal unit at St Mary's
due to the complexities of his health. Following his discharge, it took 6
weeks for the trust to send the discharge paperwork to the GP and the
District General Hospital (DGH) to whom they were transferring his
paediatric care. As a result, there was no clear understanding amongst
health professionals as to the paediatrician with responsibility for his care.
Letters were therefore copied into a mixture of paediatricians. The
discharge letter to the DGH was addressed to a consultant who was in
fact a registrar at the trust.

2. Joseph was under the care of the paediatric neurosurgical team at the
Royal Manchester Children’s Hospital (RMCH). Letters from the
neurosurgical team following out-patient appointments took 4 weeks to be
sent out. As a result one letter to a paediatric anaesthetist asking for an
examination was not typed until after the operation was due to take place.
When his mother took him for review, she had to escalate the need for
him to be seen by the paediatric anaesthetist who then deemed him not
fit at that time for surgery.

3. At ENT appointments and neurosurgery appointments at the RMCH,
Joseph was seen without the paper notes because they had not been
made available to the clinicians seeing Joseph.

4. Joseph had been diagnosed by the neurosurgeons at RMCH with
neural tube defect (cervical meningocele, hydrocephalus, Amold Chiari
type I! malformation. A recognised complication is hydrocephalus.
Identification of the onset of hydrocephalus is through measurement of
head circumference. The inquest heard that when Joseph was
discharged from St Mary's the neurosurgical team did not send written
instructions to community health professionals explaining what was
required and why it was required. The midwives measuring his head were
unsure why they were measuring it or what to do with the information.

5. Joseph's health needs relating to neural tube defect (cervical
meningocele, hydrocephalus, Arnold Chiari type |! malformation and
laryngomalacia were dealt with by the RMCH. His paediatric care was
transferred without discussion by St Mary's back to the DGH. The inquest
was told that there is no set protocol/ procedure between tertiary centres
and DGH''s for this situation, which can lead to differing practices.

6. Joseph's red book had been completed sporadically. The inquest
heard from a number of witnesses who indicated that practice re

completion of the red book amongst health professionals nationally was
mixed and that there was no clear guidance for or expectation amongst
health professionals that they would be widely used other than for post
birth weight recording and immunisations. As a result there was no
composite record of health concerns for a young child such as Joseph.
Differing IT systems meant that health professionals in different trusts
were reliant on verbal information passed to parents placing a significant
burden on parents and a risk that key information was not available.

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 fo this report within 56 days of the date
of this report, namely by 13°" December 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 7 to the following
Interested Persons namely 1) Joseph's Parents

and 2) Tameside General Hospital, who may find it useful or of interest.

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.

Alison Mutch OB
HM Senior Corone
18.10.2018

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