Prevention of Future Deaths reports · 2018

Timothy Mason

Regulation 28 report to prevent future deaths, reference 2018-0351, written 26 Oct 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report26 Oct 2018
Reference2018-0351
DeceasedTimothy Mason
CoronerRoger Hatch
Coroner areaNorth West Kent
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedMaidstone and Tunbridge Wells NHS Trust
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. The Chief Executive, Maidstone & Tunbridge Wells NHS Trust
2. NHS England

1 | CORONER

| am Roger Hatch, senior coroner, for the coroner area of Kent (North-West)

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.
[HYPERLINKS]

3 | INVESTIGATION and INQUEST

On 15" August 2018 | commenced an investigation into the death of Timothy Alastair
Mason, aged 21 years.

The conclusion of the inquest was that the medical cause of Timothy's death was ‘a.
Meningococcal Septicaemia.

The narrative verdict was due to the failure to diagnose and treat Timothy at Tunbridge
Wells Hospital and had he been correctly treated he probably would not have died.

In addition, during the course of the investigation it was clear that Timothy had not been
vaccinated with Men ACWY as his medical records confirmed. It appeared from the
evidence that there were considerable concerns for the provision of the vaccination of
people of Timothy's age, in the way they were informed of the availability of the vaccine,
the computer records of the way GP’s were informed and notified by NHS England and
monitored and what steps are being taken to improve the system to ensure people are
notified, advised and monitored to ensure they receive the vaccination in the future.

4 | CIRCUMSTANCES OF THE DEATH

On the 16 March 2018 Timothy had been unwell for several days and had been seen
by his GP. His symptoms worsened, and he attended Tunbridge Wells Hospital at 3.30
am. He was given fluid resuscitation and antibiotics. At 07.45 he was seen by

ee told he had a virus and was sent home. Timothy became worse and
returned to the hospital on the same day at 15.15 where he was given treatment despite
which he died at 21.46.

In addition, it was clear from the evidence from the Saxonbury House
Medical Group that Timothy had not received the Men ACWY vaccination it was unclear
whether he had been invited to have the vaccination, or had been and decided not to.
There seems considerable doubt as to how GP surgeries arranged for the vaccination
and the way NHS England provided the program for the doctors and monitored the

Notification of the vaccine to ensure anyone of Tim’s age would receive the vaccination..

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 could 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 reasons for the failure to correctly diagnose and treat Timothy on the 16
March 2018 at 03.30. What staff instructions were given to the doctors and
nurses in the Emergency Department at the hospital for dealing with patients
with symptoms suggestive of sepsis and what tests should have been carried
out and why they were not done.

(2) Why was Timothy discharged home on the morning of the 16 March 2018
when he was clearly very unwell and tests had not been carried out.

(3) What steps have been taken by the Trust to avoid this situation happening again
to another patient in the future.

(4) What training is being given to the doctors and nurses to avoid this situation in
the future.

(5) How it happened that Timothy did not receive the Men ACWY vaccination and
what systems are in place to ensure patients do receive the vaccination, how
this is provided and monitored by NHS England and whether this is adequate or
should be improved to avoid patients failing to receive the vaccine.

(
ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe each of 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 20" December 2018. |, 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 REI Misiones & Tunbridge Wells Trust and NHS England. |
have also sent it to Saxonbury House Surgery 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 Seronet—4

—— seed

[DATE] g ; ; a WI [SIGNED BY CORONER] C_ AN a

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 NHS England 1 (PDF)
Mr Roger Hatch  
HM Senior Coroner for North West 
Kent  
Maidstone Coroner’s Court  
Archbishop’s Palace  
Maidstone  
ME15 6YE 

Professor Stephen Powis  
National Medical Director 
6th Floor, Skipton House 
80 London Road 
SE1 6LH 

 7th March 2019 

Dear Mr Hatch, 

Re:  
Name:  
Date of Death:   16 March 2018 

Regulation 28 Report to Prevent Future Deaths 
Timothy Alastair MASON  

Thank you for your Regulation 28 Report dated 26 October 2018 concerning the death 
of Mr Timothy Alastair Mason on 16 March 2018. Firstly, I would like to express my 
deep condolences to Mr Mason’s family.  

The Regulation 28 Report concludes Timothy Mason’s death was due to the failure to 
diagnose and treat Mr Mason at Tunbridge Wells Hospital following his attendance at 
the Trust’s emergency department on 16 March 2018. A contributing factor was that 
Mr Mason had not been vaccinated with the Men ACWY vaccine. 

Following the inquest, you raised concerns in your Regulation 28 Report (Report) to 
NHS England and Maidstone and Tunbridge Wells NHS Trust regarding Mr Mason’s 
management at the Trust on the day of his death and the fact that he had not been 
vaccinated against Meningitis C. 

I am in receipt of a copy of the response to your Report from Mr Miles Scott, Chief 
Executive  of  Maidstone  and Tunbridge Wells  NHS Trust  (Trust) and have  seen  the 
action  plan  produced  by  the  Trust.  I  have  asked  the  South  East  Regional  Medical 
Director  to  follow  this  up  directly  with  the  Trust  to  ensure  that  the  actions  from  this 
tragic incident are completed. 

With reference to your final point, Saxonbury House Medical Group (Practice), and all 
GP practices that signed up to General Medical Services (GMS) enhanced services in 
2015/16, were required to offer the vaccination by actively calling eligible young people 
age 18 years on 31 August 2015, and opportunistically offering the vaccine to those 
age 19 years on 31 August 2015, and up to the age of 25 years by 31 March 2016.   

Health and high quality care for all, now and for future generations 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 As  part  of  the  GMS  contract  the  practice  had  a  responsibility  to  ensure  that 
administrative  processes  were  in  place  for  the  service  they  signed  up  to,  including 
adequate vaccination call and recall systems.  

 letter that 

It would appear from 
, a GP partner at the practice, 
reported at the inquest, that, whilst Timothy did form a part of the cohort of patients 
who should have been invited to receive the meningitis vaccination, the practice was 
unable to evidence whether he had ever been invited for the vaccination. His medical 
records  demonstrated  that  he  had  not  received  the  vaccination.  Furthermore,  the 
practice  did  not  opportunistically  offer Timothy  the  vaccination  during  appointments 
with his GP in the following years, because the Medical Information System (EMIS) 
the practice relied on to prompt such reminders only offered reminders about selected 
vaccines and did not include Men ACWY unless specifically activated to do so.  

As a result of this incident, the practice has acted to ensure that the vaccination has 
been  offered  to  all  eligible  patients.  I  can  also  confirm  that  the  practice  has  now 
switched  on  the  necessary  alerts  prompting  the  offer  for  patients  who  have  not 
received the Men ACWY vaccination. The practice has also written to EMIS requesting 
that Men ACWY is added to the list of vaccines flagged up in the alert box as a routine. 
All  local  practices  have  been  written  to  and  asked  to  check  that  the  Men  ACWY 
vaccination alert is activated and patients invited from the relevant cohort.  

During 2018/19 GP practices have continued to opportunistically offer the vaccine to 
anyone up to the age of 25. This includes those who may have missed the opportunity 
to be immunised as part of the schools-based programme. 

In  2019/20  NHS  England,  will  continue  to  offer  the  opportunistic  service  and  has 
committed  to  undertake  a  national  review  of  the  vaccination  and  immunisations 
arrangements  (https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-
2019.pdf)  which  will  include  a  review  and  clarification  of  the  expectations  around 
call/recall arrangements, reducing the risk of this incident recurring. 

Thank you for bringing these important patient safety issues to my attention and please 
do not hesitate to contact me should you need any further information. 

Yours sincerely 

Professor Stephen Powis 
National Medical Director   
NHS England  

Health and high quality care for all, now and for future generations

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