Prevention of Future Deaths reports · 2019

Alice Dixon

Regulation 28 report to prevent future deaths, reference 2019-0132, written 5 Apr 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report5 Apr 2019
Reference2019-0132
DeceasedAlice Dixon
CoronerSimon Wickens
Coroner areaSurrey
CategoryHospital Death (Clinical Procedures and medical management) related deaths
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

This report is being sent to the Chief Executive for Ashford and St Peter’s Hospitals NHS
Foundation Trust

CORONER

Jessica Russell-Mitra, Assistant Coroner for Surrey

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.
http://www. legislation. gov.uk/uksi/2013/1629/part7/made

INVESTIGATION AND INQUEST

On 27" june 2017, Mr Simon Wickens, Area Coroner for Surrey opened an Inquest into the
death of Mrs Alice Doris Dixon, who died at St Peter’s Hospital, Surrey on 17*" June 2017,
aged 83 years old. The investigation concluded at the end of the Inquest on 28" November
2018.

CIRCUMSTANCES OF DEATH

At the end of the Inquest | recorded the following narrative:

On 10" June 2017 Alice Doris Dixon attended St Peter’s Hospital A&E on referral from her
general practitioner due to increasing anaemia and shortness of breath. As part of the
investigation of her condition, a CT scan was requested. Alice was kept on the ward
overnight and at about 10.35am on 11" June 2017 she attended the radiology department
accompanied by her daughter. She was taken into the radiology scanning room without her
daughter and asked questions for a consent form which was not signed by her or anyone on
her behalf and was not signed by the radiographer. Some details of her previous scans and
her renal funcrion were checked. Her hearing and cognisance were not checked in detail nor

I

was her fitness or her ability to lie flat. Alice was noticeably wheezing before the scan
commenced. The CT scan was started and it took about 3-4 minutes in tota!. During the
course of the scan contrast dye was injected via a pre-placed cannula. Alice suffered an
anaphlyactic shock including severe bronchospasm. She was found after the scan by the
radiographer to be unresponsive and she became cyanotic. Resuscitation commenced and
ROSC was established. Alice was admitted to ITU in grave condition and deteriorated: no
further intervention was considered possible. She was transferred to Holly Ward where she
was treated palliatively and died as a result of the consequences of the anaphylactic shock.

MEDICAL CAUSE OF DEATH

The medical cause of death was:-
la cardio-respiratory failure

1b Cardio-respiratory arrest

1c Anaphylactic shock secondary to Computed tomography contrast media on a background
of anaemia of uncertain aetiology.

2 General frailty atrial fibrillation colitis and gastritis

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:

1. The evidence before the court suggested that Mrs Dixon was not accompanied or
escorted by a medical professional to the radiography suite.

2. Her daughter was not invited into the room when the pre-scan form was completed.
3. The consent form was filled in by the radiographer on asking questions of Mrs Dixon
alone who was vulnerable, unwell, confused and hard of hearing in an unfamiliar

environment without assistance.

4. The consent form was also supplemented with information from the computer
records but it was not clear on the form or in evidence which information came from
Mrs Dixon and which from records.

5. Part of the consent form was filled in and initialled by a person who cannot be
identified by the Trust as to which member of staff it was.

6. Part of the consent form about previous contrast was left blank and although the
RCA had the information before the scan it was not noted.

7. The radiographer who filled in the form had no training in communication or
language difficulties and there were no other resources to aid communication and
the questions were yes/no.

8. No notes were made in the radiography suite.

9. Mrs Dixon was assessed before attending the radiography suite but there was no
one with clinical skills to assess her prior to the scan itself and .

10. There was no note to assist the radiographer with any vulnerabilities Mrs Dixon had
(including crucially hearing and understanding difficulties and that she was not able
to lie flat)

11. The way the room was set up it was difficult for the radiographer to realise that Mrs
Dixon was having breathing difficulties during the scan as he was only able to see the
top of her head and it was hard for him to hear over the sound of the scanner
through the intercom in the scanner itself.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of this report, namely by 3
July 2019. | may extend the period.

Your response must contain details of action taken or proposed to be taken and a timetable
for action. Otherwise, please provide explanation why no action is taken.

COPIES AND PUBLICATIONS

| have sent a copy of my report to the Chief Coroner and to Mrs Dixon’s family. | have also
sent a copy to

| have sent a copy of my report to Surrey County Council who may find it useful or of
interest.

1am 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 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.

Dated: 5‘ April 2019

Je hile

Jessica Russell-Mitra, HM Assistant Coroner Surrey

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