Prevention of Future Deaths reports · 2021

Valmai West

Regulation 28 report to prevent future deaths, reference 2021-0239, written 13 Jul 2021. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report13 Jul 2021
Reference2021-0239
DeceasedValmai West
CoronerCaroline Saunders
Coroner areaGwent
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Wales prevention of future deaths reports (2019 onwards)
Sourcejudiciary.uk record · original PDF
Responses published1

The report

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

Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013 

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1. (cid:9) Chief Executive of Aneurin Bevan University Health Board 

1 

CORONER 

2 

3 

1 am Caroline Saunders, Senior Coroner for the Area of Gwent 

CORONER'S LEGAL POWERS 

1 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 28/1/2020 an investigation was opened into the death of 

Valmai Ann WEST 

The investigation concluded at the end of the inquest on: 1/7/2021 

The conclusion of the inquest was recorded as: 

Death By Accident 

The medical cause of death was: 

1a)  Intracranial Haemorrhage 

1b)  Fall 

4 

CIRCUMSTANCES OF THE DEATH 

Valmai West suffered 2 falls in the community on 111h  and 16th  January 2020 

respectively and attended the Emergency Department of the Royal Gwent 

Hospital. On neither occasion did she present with any signs of intracranial 

haemorrhage or cerebral irritation. Mrs West had also suffered a fracture of 

her pubic ramus on 16th  January and was admitted to hospital for management 

of the fracture and rehabilitation. On 20th  January Mrs West was found to be 

unresponsive and a CT scan demonstrated an extensive subdural 

haemorrhage. The effect of this bleed was devastating and Mrs West died on 

22nd  January 2020 at the Royal Gwent Hospital. 

 5 

CORONER'S CONCERNS 

During the course of the inquest, 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. (cid:9) Staffing Levels in the Emergency Department of Royal Gwent Hospital 

During the course of the inquest, consideration was given to the the clinical 

decisions made in the Emergency Department of the Royal Gwent Hospital. I 

concluded that there was no evidence that Mrs West was displaying signs that 

would alert the staff to a possible intracranial bleed. However in evidence Dr 

, Consultant in Emergency Medicine, acknowledged that the staff 

had not followed hospital protocol or the NICE guidance in relation to the 

frequency with which observations should be performed. Dr 

' assessment 

of the situation was that this was probably caused by inadequate staff 

numbers to undertake the full range of duties required. She further stated that 

this is a frequent and ongoing problem in the Emergency Department. 

Whilst this did not influence the outcome for Mrs West I am concerned that 

this may put the lives of future patients at risk. 

6 

ACTION SHOULD BE TAKEN 

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

the power to take such action. 

I should be grateful if the following information be provided to me: 

1. (cid:9) Confirm whether any steps have or will be taken to address the staffing levels 
within the Emergency Department or other steps to ensure that there is 
sufficient capacity to undertake essential duties such as neurological 

observations. 

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this 
report, namely 06.09.21,  I, the Coroner, may extend this 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 necessary. 

 8 

COPIES AND PUBLICATION 

I have sent a copy of my report to the Chief Coroner and the following Interested 
Person (s) 

•  The family of Valmai Ann WEST 

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 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 

DATE 13/7/21 

Signed 

Ca2~,, 6 -r 

Caroline Saunders 

Her Majesty's Senior Coroner for the Area of Gwent.

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 Aneurin Bevan University Health Board (PDF)
QG  Bwrdd lechyd Prifysgol 
Aneurin Bevan
HS  University Health Board 

3 September 2021 

Caroline Saunders 
Her Majesty's Senior Coroner for the area of Gwent 
The Civic Centre 

Dear Ms Saunders 

Re: Aneurin Bevan University (Health Board response to Regulation 
28 Report received following the inquest touching upon the 
death of Mrs Valmai Ann West, DOB 05/10/1939 

Thank you for your report dated 13th July 2021, which was received by the 
Health Board on the 14th July 2021. The information within the response 
letter has been compiled by 

, Executive Director of Nursing. 

In response to your report, the information provided is intended to address 
s during the course of the inquest. It 
the concerns raised by Dr 
was acknowledged that staff had not followed hospital protocol or NICE 
guidelines in relation to the frequency of which observations should be 
performed. Dr 
assessment of the situation was this was probably due 
to inadequate nurse staffing levels within the Emergency Department. 

Following receipt of the Regulation 28 Report a review of the nurse staffing 
levels was undertaken by the Senior Nurse Manager of the Emergency 
Department. I can confirm nurse staffing levels at the index time were 
appropriate and adequate and as per the roster for the area the patient was 
cared for. The staffing levels would not have impacted on the ability to 
undertake neurological observations. 

I thought it would be helpful to share that an in-depth review of nurse 
staffing levels for the Emergency Department (ED) at the Grange University 
Hospital was commissioned as a result of the early opening of the hospital 
and in light of increased patient demand. This has been undertaken by the 

Bwrdd lechyd Prifysgol Aneurin Bevan 
Pencadlys, 
Ysbyty Sant Cadog 
Ffordd Y Lodj 
Caerilion 
Casnewydd 
De Cymru NP15 3XQ 
Ff6n: 01633 436700 
E-best: abhb.enquiries@wales.nhs.uk 

Aneurin Bevan University Health Board 
Headquarters 
St Cadoc's Hospital 
Lodge Road 
Caerleon 
Newport 
South Wales NP18 3XQ 
Tel No: 01633 436700 
Email: abhb.enquiries@wales.nhs.uk 

Bwrdd Iechyd Prifysgol Aneurin Bevan  yw envy gweithredol Bwrdd Iechyd Lleol Prifysgol Aneurin Bevan 

Aneurin Bevan University Health Board is the operational name of Aneurin Bevan University Local Health Board 

 
 
 
	
 
 
 
 
 
 
 -2-

Senior Nurse Manager for ED and the Assistant Head of Nursing, supported 
by the Deputy Director of Nursing. The assessment is based on RCN 
Guidance, RCEM Guidance, Nurse Staffing Levels (Wales) Act 2016 and, 
importantly, professional judgement. A similar review of medical staffing is 
also being undertaken. 

I hope this additional information in relation to the matters raised is helpful 
in terms of clarification but also as an update on progress and assurance in 
relation to nurse staffing levels within the Emergency Department at the 
Grange University Hospital and those raised in regards nurse staffing levels 
at the time of the incident. Do not hesitate to contact me should you require 
any further information. 

Yours sincerely 

Prif Weithredwr/ Chief Executive

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