Prevention of Future Deaths reports · 2019

Joyce Marchant

Regulation 28 report to prevent future deaths, reference 2019-0429, written 16 Dec 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report16 Dec 2019
Reference2019-0429
DeceasedJoyce Marchant
CoronerAlison Mutch
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedManchester University NHS Foundation Trust · Tameside and Glossop Integrated Care 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, Greater
Manchester Health and Social Care Partnership, Chief Executive of NHS
England

CORONER

lam Alison Mutch, Senior Coroner, for the Coroner Area of Greater Manchester
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 4" June 2019 | commenced an investigation into the death of Joyce
Marchant. The investigation concluded on the 9'" December 2019 and the
conclusion was one of Narrative: Died from the complications of a liver
abscess where the presence of the abscess was not recognised until an
ultra sound on 28th May 2019 and a biopsy to drain it could not be
accommodated until 31st May 2019. The medical cause of death was 1a)
Multi organ failure; 1b) Biliary sepsis with liver abscess ;1c)
Choledocholithiasis

CIRCUMSTANCES OF THE DEATH

Joyce Marchant had a history of stones in the liver. A series of
complex ERCP'’s in 2018 removed the stones. AMRCP on 24th
January 2019 showed no residual stones. She was seen on 21st May
2019 in the outpatient clinic - liver function tests were normal. She had
a raised CRP. That was reported via letter to her General Practitioner
(GP). The fetter was not received and she was not aware of it. Over
the next few days she felt unwell. On 25th May 2019 she went to the
Emergency Department at Tameside General Hospital. Her CRP was
very high. She was treated for an infection with antibiotics and fluid. An
x-ray showed no consolidation. No further tests were carried out until
an ultra sound performed on 28th May 2019 at 11:32 am suggested
biliary sepsis and queried an abscess. An abscess would not of itself
respond to antibiotics and required drainage to reverse the effects. It is
probable that she was well enough to undergo a drainage procedure at
that time. A review that evening resulted in a CT scan on 29th May
2019. On 29th May she was deemed too unwell to transfer to
Manchester Royal Infirmary. The radiologist at Tameside General

Hospital could not accommodate a drainage procedure until 31st May
2019. There was no further discussion of the options at that stage. She
continued to deteriorate and was placed on end of life care on 30th
May 2019. She died at Tameside General Hospital on 1st June 2019.

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. During the course of the Inquest the evidence given was that the delay in
offering the drainage procedure was attributable to a shortage of
interventional radiologists which meant that the Trust could not
accommodate the need for a drainage procedure until 31° May. There
was greater availability at tertiary centres but transfers to a tertiary centre
could take time and not be practicable. The inquest heard that if she had
been at the tertiary centre when the abscess was identified she would
probably have had the drainage procedure almost straight away;

2. The inquest heard that the Manchester Royal Infirmary use the postal
system to provide GPs with information about blood results/follow up
information. Faxes are no longer used due to GDPR. The trust propose
to move to an email system for notifying GPs recognising that the use of
the postal system carries delay and risk of information not reaching the
GP(7% was the figure given to the inquest). Their IT system at this time
is not capable of this information transfer and the information was that it
would be about another 2-3 years before that was achieved. In the
interim they would continue to use the postal system;

3. The MRI was the treating centre for Mrs Marchant’s underlying medical
problems which led to her deterioration. However there was no evidence
of a clear communication strategy or treatment plan involving the DGH
and Tertiary Centre. This was attributed in part to the sheer volume of
demand on tertiary centres and the extent of support they can provide to
DGHs.

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 to this report within 56 days of the date of this
report, namely by 10" February 2020. !, 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 namely 1 Mon behalf of the family 2)
Tameside and Glossop Integrated Care NHS Foundation Trust via Weightmans
solicitors 3) Manchester University NHS Foundation Trust via Hempsons
solicitors, who may find it useful or of interest.

lam 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 OBE
HM Senior Coroner
16.12.2019

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