Prevention of Future Deaths reports · 2020

Paul Reynolds

Regulation 28 report to prevent future deaths, reference 2020-0178, written 21 Sep 2020. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Sep 2020
Reference2020-0178
DeceasedPaul Reynolds
CoronerIan Arrow
Coroner areaPlymouth, Torbay and South Devon
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION  28  REPORT TO  PREVENT FUTURE  DEATHS 

THIS  REPORT IS  BEING  SENT TO: 
The  Medical Director,  Derriford Hospital, Derriford,  Plymouth,  PLG  8DH 

1 

CORONER 
I am  Ian Michael Arrow,  Senior Coroner for Plymouth Torbay and  South Devon 

2 

CORONER'S LEGAL POWERS 

I 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/ukpga/2009/25/schedule/5/paragraph/7 
http://www.legislation.gov. uk/uksi/2013/1629/part/7 /made 

3 

INVESTIGATION and  INQUEST 

An  Inquest into the death  of Paul Vincent Reynolds (dob:  22 September 1965) was 
opened  on  7 January 2020 and  heard  on  18 September 2020. 

The Coroner recorded the following NARRATIVE verdict 

The  deceased  suffered  from  learning  difficulties  and  comorbidities  which  made 
him vulnerable. 

He  presented  to  hospital  with  a  swollen  hand.  One  finger  became  necrotic  and 
required amputation. 

A  decision  was  made  on  initial  information  to  carry  out  surgery  on  the  finger 
under general  anaesthetic. 

The  Deceased's  full  hospital  notes  were  not  available  and  the  deceased  had 
limited discussion with  medical staff. 

incomplete  appreciation  and  understanding  of  the  patients  underlying 

The 
medical condition  led to  an  inappropriate choice of monitoring and anaesthetic. 

The  deceased  suffered  a  loss  of  blood  pressure  and  then  had  a  hypoxic  period 
following  administration of general anaesthetic. 

He  deteriorated  and  died  from  the  hypoxic  event  on  31  December  2019  at 
Derriford  Hospital. 

4 

CIRCUMSTANCES OF THE  DEATH 
The  deceased  suffered  a  hypoxic  period 
anaesthetic. 

following  administration  of  a  general 

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. 

A Root Cause Analysis by an  Independent Anaesthetist found:-

Root Cause 

There  was  an  incomplete  appreciation  and  understanding  of  the  patients  underlying 
medical condition which  led  to  an  incorrect choice of monitoring and  anaesthetic. 

The  unavailability of the full  patient  record  meant that the  anaesthetic team  were  reliant 
on  the  patient history and  the  admission clerking  record to  assess the  patient. 

Lessons  Learned 

The  full  set  of patient  medical  records  must  be  obtained  as  soon  as  possible  following 
admission  particularly when  a procedure involving anaesthesia is  planned. 

The  safe  conduct  of  anaesthesia  is  reliant  on  being  fully  conversant  with  the  patient's 
pre-existing  medical  conditions  and  patients  should  not  be  anaesthetised  before  the 
medical records  have been  obtained  and  reviewed. 

Recommendations 

1.  Medical  records  must  be  obtained  as  soon  as  possible  following  admission  to 

the ward  by a ward clerk. 

2.  The  ward  administration  team  must  check  daily  that  all  medical  records  are 
available  or  have  been  requested  and  an  expected  time-frame  for  the  medical 
records to  be  available. 

3. 

If adequate patient records  are not available,  the  patient should  not go to  theatre 
unless it is  a life or limb threatening  emergency. 

6 

ACTION  SHOULD BE TAKEN 

In  my  opinion  action  should  be  taken  to  prevent  future  deaths  and  I  believe  you  as 
Medical  Director  of  the  relevant  Trust  have  the  power  to  take  such  action.  Please 
confirm  the  recommendations  of  the  Root  Cause  Analysis  have  been  implemented. 

7 

YOUR RESPONSE 

You  are  under a duty to  respond  to  this  report within  56  days  of the  date  of this  report, 
namely by  17  November 2020.  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. 

8 

COPIES and  PUBLICATION 

I  have  sent  a  copy  of my  report  to  the  Chief  Coroner  and  to  the  following  Interested 
Persons:-
The family. 

I 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. 

9

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 University Hospitals Plymouth (PDF)
University Hospitals 
Plymouth 

Dr 
 MBBS MRCP FRCP 
Medical  Director and Cons.  Radiologist 
Department of Clinical  Management Level 07 
University Hospitals Plymouth NHS Trust 
Derriford  Road 
Crownhill 
Plymouth 
PL6 8DH 

Tel: 

www.plymouthhospitals.nhs.uk 

29th  October 2020 

PRIVATE & CONFIDENTIAL 
Mr Ian Arrow 
Senior Coroner 
Her Majesty's Coroner for the County of Devon 
Plymouth,  Torbay and South  Devon 
1 Derriford  Park 
Derriford Business Park 
Plymouth  PL6 5QZ 

Dear Mr Arrow, 

Re:  Paul Vincent Reynolds (dob.  22 September 1965) 

I write in  response to the Regulation  28 report dated 21 st  September,  raising  concerns 
regarding the unavailability of full  patient records and incomplete appreciation and 
understanding  of a patient's underlying medical condition. 

I can  confirm that the three recommendations listed in  the report have indeed  been fulfilled. 

I hope the above serves to provide assurance around the actions we are taking  in  respect of 
the concerns that you  have raised and that these will  help prevent future deaths of this 
nature. 

Yotl?~:--~ 

Dr 
Me,dical  Director 
?/ 

cc. 

,  Legal  Manager,  University Hospitals Plymouth NHS Trust 

_/MINDFUL 
VEMPLOYER 

Working in partnership with  the  Peninsula  Medical School 

Chairman: 

  Chief Executive:

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