Prevention of Future Deaths reports · 2019

Maureen Jarvis

Regulation 28 report to prevent future deaths, reference 2019-0357, written 11 Sep 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report11 Sep 2019
Reference2019-0357
DeceasedMaureen Jarvis
CoronerAndrew Haigh
Coroner areaStaffordshire (South)
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Mental Health related deaths
Organisation namedMidlands Partnership University NHS Foundation 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.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:
Mr Neil Carr OBE
Chief Executive
Midland Partnership Foundation NHS Trust
Mellor House
Corporation Street
Stafford
ST16 3SR

=

CORONER
| am Mr Andrew Haigh senior coroner for the coroner area of Staffordshire South

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 24 August 2018 | commenced an investigation into the death of Maureen
Margaret Jarvis aged 72 years. The investigation concluded at the end of the
inquest on 10 September 2019. The conclusion of the inquest was ‘naturally
occurring ulcer that was not diagnosed until after it had burst’ with the death having
resulted from a perforated duodenal ulcer.

CIRCUMSTANCES OF THE DEATH

(a) Maureen Margaret Jarvis (known as Mandy) was compulsory detained under
section 3 of the Mental Health Act at the George Bryan Centre (GBC) Tamworth. On
the 15'" August 2018 she was taken to Good Hope hospital where she died on the
17" August 2018 due to the effects of a burst ulcer.

(b) At times staff at GBC were aware of Mandy being in pain. A full physical
examination did not take place on admission although this was policy, nor at any
other time during the rest of her time at GBC. Mandy did not provide her consent
and it was deemed not appropriate to force her. The lack of full physical examination
is a possible causative factor in her death. A further consideration is the failure to
keep correct and accurate records. The level of personal care Mandy received could
have been improved.

CORONER’S CONCERNS

During the course of the inquest the evidence revealed a matter 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 MATTER OF CONCERN is as follows. —

During her final admission to the George Bryan Centre Mrs Jarvis did not have a
proper medical examination by a doctor. The reasons given for this were that she
would not consent and that her condition never warranted this being done on a non-
consensual basis. Among other witnesses | heard helpful evidence from the

Consultant Psychiatris ho indicated that this was a
difficult area and also from SM (the lead author of the Serious Incident
Review) who believed there was a policy about this but could not be specific. It
strikes me that there should be a clear policy about physical health examination of
admitted psychiatric patients and this should be disseminated to all staff involved.

ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and | believe you and
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 6 November 2019. 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:

Irwin Mitchell solicitors for the Jarvis Family

Capsticks solicitors for your Trust.

| have also sent it to the following persons who may find it useful or of interest:
Care Quality Commission
University Hospitals Birmingham NHS FoundationTrust.

| 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.

11 September 2019

| oa

Andrew A Haigh

HM Senior Coroner for Staffordshire (South)
Coroner's Office

No 1 Staffordshire Place

Stafford

ST16 2LP

Tel No: 01785 276127
sscor@staffordshire.gov.uk

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 Midland Partnership NHS Trust (PDF)
NHS)

Midlands Partnership
NHS Foundation Trust
A Keele University Teaching Trust

Neil Carr

Chief Executive
Trust Headquarters
St George’s Hospital
Corporation Street
Stafford

ST16 3SR

Tel: 0300 790 7000

Mr A Haigh

HM Senior Coroner for Staffordshire (South)
Coroner’s Office

No 1 Staffordshire Place

Stafford

ST16 2LP

17" October 2019

Dear Mr Haigh,

RE: Maureen Margaret (known as Mandy) Jarvis

Thank you for your letter dated 11" September 2019, reporting a matter to us, in accordance
with Regulations 28 and 29 of the Coroner's (Investigations) Regulations 2013.

May | take this opportunity to reassure you that following Mrs Jarvis’ death, we undertook a
thorough investigation into the care delivered by the Trust.

Following discussions both within the mental health Services in the Staffordshire and Stoke
Care Group and across the wider Trust, | am now in a position to respond to your specific
concerns, raised by you during the course of the evidence you heard at the inquest.

1. Area of concern; “during her final admission to the George Bryan Centre Mrs Jarvis did
not have a proper medical examination by a doctor. The reasons given for this were that
she would not consent and that her condition never warranted this being done on a non-

consensual basis. Among other witnesses | heard helpful evidence from the Consultant
Psychiatrist who indicated that this was a difficult area and also
fro (the lead author of the Serious Incident Review) who believed

there was a policy about physical health examination of admitted psychiatric patients and
this should be disseminated to all staff involved.”

In response we can confirm that a policy and Standard Operating Process (SOP) existed at
the time of Mrs Jarvis’s death. These outline the responsibilities and expectations of
inpatient staff to undertake physical health investigations on admission and also the
expectation in the circumstance of refusal to consent to continue to attempt during the

NHS)

Midlands Partnership
NHS Foundation Trust
A Keele University Teaching Trust

admission. These documents are currently due for review as part of the continuous
improvement and ratification cycle. Following changes in recording of investigations in our
electronic health record system further guidance was developed to sit alongside these

SOP’s.
mental

| can confirm that these documents have been circulated to all the staff on our
health inpatient wards and are being referenced in new inpatient staff local

inductions.

In addition several actions have been completed to further enhance the physical health care
of our patients admitted to our mental health units. These include:

>

Please

The ward staff on Milford Unit (previously the George Bryan Centre West Wing) have
undertaken bespoke training in order to further develop their knowledge and
understanding of common physical health difficulties.

An electronic dashboard has been developed to provide an “at a glance” view of
whether key physical health assessments and investigations have been completed
and recorded on the electronic health record in the appropriate form. This is utilised
in clinical discussions on the ward as a live audit tool.

The ward has secured regular input from an Advanced Nurse Practitioner to
specifically to support the physical health needs and monitoring of patients on the
ward.

Ward staff reminded to record consent and/or lack of capacity to consent to a
physical health assessment within RiO and if either lacking preventing assessment to
regularly revisit and record attempts.

Dissemination of the Physical Health Policy and SOP as part of the junior doctors
induction

find enclosed a copy of the full action plan developed as a result of the investigation.

| hope this response helps to address your concerns. However, if you require any further
information please do not hesitate to contact me

Yours sincerely

z

t

eil Ca
Chief Executive

MPFT

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