Prevention of Future Deaths reports · 2020

Clara Moniatis

Regulation 28 report to prevent future deaths, reference 2020-0221, written 3 Nov 2020. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report3 Nov 2020
Reference2020-0221
DeceasedClara Moniatis
CoronerCaroline Beasley-Murray
Coroner areaEssex
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedBarts Health NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published1

The report

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

ANNEX A 

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

NOTE: This form is to be used after an inquest. 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

Barts and Whipps trust 

1 

CORONER 

I am Caroline Beasley-Murray, senior coroner, for the coroner area of Essex 

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. 

3 

INVESTIGATION and INQUEST 

On 15 May 2019 I commenced an investigation into the death of Clara Iris Moniatis.. The 
investigation concluded at the end of the inquest on 7 October 2020. The conclusion of 
the inquest was:- 

Clara Iris Moniatis had been unwell for some days and on the morning of 5 May 
2019 she was taken to the Emergency Department of Whipps Cross Hospital. 
Despite medical treatment, she died there at 18.56pm that evening. She died of 
Natural Causes. 

4 

CIRCUMSTANCES OF THE DEATH 

The cause of death was 1a) dilated cardiomyopathy.  
This condition had been previously undiagnosed  

Please see above 

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.  The matter of waiting times from chest x-ray to the review of the imaging 
2.  The matter of the need for a system whereby a PEWS alert leads to a prompt 

clinical review 
ACTION SHOULD BE TAKEN 

6 

In my opinion action should be taken to prevent future deaths and I believe you and your 

1 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 organisation have the power to take such action.  

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 18th December 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- 
solicitors for 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 

3 November 2020                                             Caroline Beasley-Murray 

2

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 Barts Health NHS Trust (PDF)
16 December 2020 

PRIVATE & CONFIDENTIAL 

Ms Caroline Beasley-Murray 
HM Senior Coroner  

Trust Executive Office 
Ground Floor 
Pathology and Pharmacy Building 
The Royal London Hospital 
80 Newark Street 
London E1 2ES 

Telephone: 

Chief Medical Officer 

Dear Ms Beasley-Murray  

RE: Regulation 28:  Report to Prevent Future Deaths 

www.bartshealth.nhs.uk 

I  write in  response to the  recent  Regulation  28:   Report to Prevent  Future Deaths  notice  regarding 
the care of Clara Moniatis. 

Clara, a 5 month old child, was bought to the Whipps Cross Hospital (WCH) Emergency Department 
(ED)  by  her  parents  with  worsening  symptoms  of  possible  tonsillitis.  Having  been  clinically  stable, 
Clara  deteriorated  rapidly  after  5  hours  in  the  department  and  arrested,  resuscitation  was 
unsuccessful. Post mortem examination identified previously undiagnosed dilated cardiomyopathy.   

The matters of concern raised in the Regulation 28 notice were: 

1.  The matter of waiting times from chest x-ray to the review of the imaging 
2.  The matter of the need for a system whereby a PEWS alert leads to a prompt clinical review 

We have previously noted that the documented timings of x-ray review represent a maximum time, 
as notes are often made in retrospect within a busy emergency department.   

Following a thorough review of our own investigation findings and the views of the Coroner’s expert 
witness, and taking into account that Clara was seen by a senior specialist doctor within 20 minutes 
of her PEWS increase, we believe we could have done nothing which would have prevented Clara’s 
sad  outcome.  However,  this  has  reaffirmed  the  critical  importance  of  early  senior  review  of 
deteriorating  patients,  following  national  guidelines  on  the  escalation  protocol  for  PEWS,  and  we 
have shared the learning widely among our clinical staff.   

Yours sincerely 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Chief Medical Officer  
Barts Health NHS Trust

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