Prevention of Future Deaths reports · 2019

Ronald Clark

Regulation 28 report to prevent future deaths, reference 2019-0151, written 8 Apr 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report8 Apr 2019
Reference2019-0151
DeceasedRonald Clark
CoronerDavid Clark
Coroner areaPortsmouth and South East Hampshire
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Product 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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:

1. The Medicines and Healthcare Products Regulatory Agency
2. NHS Improvement

1 | CORONER

| am David Clark Horsley, senior Coroner for the Coroner area of Portsmouth and South
East Hampshire.

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

On 21 May 2018 | commenced an investigation into the death of Ronald CLARK age 64.
The investigation concluded at the end of the inquest on 15 February 2019. The
conclusion of the inquest was cause of death: 1a. Multi-organ Failure, 1b. Necrotising
Pancreatitis, 2. Chronic Obstructive Pulmonary Disease. Ronald CLARK died due to an
Accident.

4 | CIRCUMSTANCES OF THE DEATH

On the Nineteenth January 2018 Ronald CLARK underwent the insertion of a stent in
his common hepatic duct. The incorrect sized stent was inadvertently inserted and this,
on the balance of probabilities, significantly contributed to his death at Queen Alexandra
Hospital, Portsmouth on Second of April 2018.

5 | 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. | was told in evidence that the stents used at the hospital are all supplied in
identical packaging with only a small label identifying the size of the stents
inside. | was also told that stents in this sort of packaging are in general use in
most, if not all, NHS hospitals.

2. | believe action should be taken by the purchasing agencies of the NHS to
ensure that stent manufacturers should supply different sizes of stents in
different coloured packaging to make it easier for them to be identified during
medical procedures and to obviate the risk of the wrong-sized stent being used,
as was the case with Mr Clark.

6 | ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe 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 4" June 2019. |, 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 Mr Clarks family and Queen Alexandra Hospital, Portsmouth.

| 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.

08 April 2019 David Cfark Horsley

AO

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 (PDF)
Mr David C Horsley LLB, Solicitor 
Her Majesty’s Coroner for 
Portsmouth and South East Hampshire 
The Coroner’s Court 
1 Guildhall Square 
Portsmouth 
PO1 2GJ 

Wellington House 
133-155 Waterloo Road 
London 
SE1 8UG 

6th June 2019 

Dear Mr Horsley 

Regulation 28 Report – Mr Ronald CLARK 

Thank you for the Regulation 28 report dated 8 April 2019, that was received on 23 
April 2019.  Although your report was directed at NHS Improvement, NHS England 
and NHS Improvement have been operating as a single organisation since 1 April 
2019. This response is provided in my capacity as the National Director of Patient 
Safety, NHS Improvement.  

I am grateful to you for sharing your findings from the inquest with us and 
highlighting that actions could prevent future deaths.  The main action that you 
highlight relates to changes to manufacturer’s packaging so that different-sized 
stents are in different-coloured packaging.  I note that the Regulation 28 report has 
also been sent to the Medicines and Healthcare products Regulatory Agency and, as 
changes to packaging falls within their remit, they are the more appropriate body to 
respond on this specific action. 

The related action that I have been able to take, to reduce the potential for such 
incidents from happening again, is detailed below. 

The National Patient Safety Team, being part of NHS Improvement, is in the process 
of reviewing the National Safety Standards for Invasive Procedures (NatSIPPs).  
These are a set of high-level, national standards for all invasive procedures that 
have been produced to support local providers in developing and maintaining their 
own more detailed standardised local procedures and in order to reduce the 
likelihood of Never Events occurring. 

The NatSIPP on prosthesis verification is being updated to reflect developments in 
implant selection and verification processes and will include the potential for future 
scanning for all prothesis/implants. 

NHS England and NHS Improvement 

 
 
 
 
 
 
 
 
 
 
 
 
 
 I hope you will be able to share my reply with Mr Clark’s family. I was very sorry to 
hear that this error occurred, and I hope it will give the family some comfort that we 
are taking steps to prevent this type of error in future.  

I trust that you will find this information of assistance and should you require any 
further detail, please do not hesitate to contact me.    

Yours sincerely, 

Dr Aidan Fowler, MBBS, FRCS 

National Director of Patient Safety 

NHS Improvement 

NHS England and NHS Improvement

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