Prevention of Future Deaths reports · 2021

Susan Merton

Regulation 28 report to prevent future deaths, reference 2021-0375, written 9 Nov 2021. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report9 Nov 2021
Reference2021-0375
DeceasedSusan Merton
CoronerJohn Gittins
Coroner areaNorth Wales (East and Central)
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.

John Adrian Gittins 
Senior Coroner for North Wales (East and Central) 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO:  BCUHB, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, 

Gwynedd LL57 2PW 
CORONER 

1 

I am John Adrian Gittins, Senior Coroner for North Wales (East and Central)                     

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 the 23rd of  August 2019 I commenced an investigation into the death of Susan Merton (DOB 
1.3.54 DOD 23.8.19) The investigation concluded at the end of the inquest on the 5th of 
November 2021. The conclusion of the inquest was one of a death arising from natural causes 
with the cause of death being 1(a) Sepsis (b) Extrahepatic Biliary Obstructions, Pancreatitis (c) 
Common Bile Duct Stone 2. Hypertensive Heart Disease 

4 

CIRCUMSTANCES OF THE DEATH 

The circumstances of this death are that the deceased had undergone a CT scan, the reporting 
of  which failed to identify the presence of a common bile duct stone. When this was later 
recognised and appropriate treatment was scheduled to take place, the deceased’s condition 
suddenly deteriorated acutely and she passed away at Glan Clwyd Hospital on the 23rd of 
August 2019. 

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.  Evidence provided to me in the course of the investigation indicated that the Health 

Board had conducted an investigation and had produced an Action Plan in light of the 
f indings of that investigation. The Action Plan required that the recommendations 
contained therein be reviewed in a Clinical Governance Meeting on the 5th of August 
2021 however f or reasons which could not be explained at the inquest, this was not 
done. 

2.  On previous occasions I have issued regulation 28 reports expressing concerns that the 
Health Board continually fail to accomplish actions in circumstances where they have set 
their own timeframe. 
I am concerned that as a result of the Health Board failing to follow through with their 
own actions and recommendations either in a timely manner or in this specific case at 
all, lives are being put at risk. 

3. 

Coroner's Office, County Hall, Wynnstay Road, Ruthin, LL15 1YN 
Tel 01824 708047    |    Fax 01824 708048 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 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. 

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, namely by 
28th of  December 2021 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 Family of the Deceased and to the Chief Coroner. 

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 

Dated 9th November 2021 

Signature 

Senior Coroner for North Wales (East and Central) 

Coroner's Office, County Hall, Wynnstay Road, Ruthin, LL15 1YN 
Tel 01824 708047    |    Fax 01824 708048

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 Bcuhb (PDF)
Bloc 5, Llys Carlton, Parc Busnes Llanelwy, 
Llanelwy, LL17 0JG 

---------------------------------- 

Block 5, Carlton Court, St Asaph Business 
Park, St Asaph, LL17 0JG 

Dyddiad / Date:   11th January 2022  

Mr John Gittins  
Senior Coroner 
North Wales (East and Central) 
Coroner's Office 
County Hall 
Wynnstay Road 
Ruthin  
LL15 1YN 

Dear Mr Gittins,  

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 
Susan Merton  

I write in response to the Regulation 28  Report to Prevent of Future Deaths issued by 
yourself to Betsi Cadwaladr University Health Board, following the inquest touching the 
death of Susan Merton.  

I would like to begin by offering my deepest condolences to the family and friends of Ms 
Merton, and I apologise for the concerns identified at the inquest that have given rise to 
your notice. I also apologise that this is the second notice you have issued in regards to 
the completion of actions following serious incident investigations.  

I would like to assure you that direct conversations have been held with the responsible 
service and we are providing close oversight of quality and safety in that area.  

As  outlined  in my  response  to  the  Regulation  28  regarding  Mr Hurst,  we  changed  our 
serious  incident  process  in  April  2021.  From  this  date  all  investigation  reports  are 
submitted for scrutiny and approval at an Incident Learning Panel. This new step in the 
process adds an organisational level of scrutiny on all investigations completed by our 
clinical divisions and we have seen an improvement in the quality of reports and action 
plans  as  a  result.  A  report  without  an  action  plan  would  not  be  accepted.  I  am  very 
disappointed  that  our  service  did  not  complete  an  action  plan  when  they  should  have 
done, nor was it completed on the right template when it was. Our new process ensures 
this cannot happen.  

We  are  also  now  tracking  actions  from  these  investigation  reports  and  action  plans 
through our Datix patient safety system and auditing compliance with action completion 
timeframes and evidence.  

Cyfeiriad Gohebiaeth ar gyfer y Cadeirydd a'r Prif Weithredwr / Correspondence address for Chairman and Chief Executive: 
Swyddfa'r Gweithredwyr / Executives’ Office 
Ysbyty Gwynedd, Penrhosgarnedd 
Bangor, Gwynedd LL57 2PW 

Gwefan: www.pbc.cymru.nhs.uk / Web: www.bcu.wales.nhs.uk 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
   
 
    
 
 
 
 
 This new process covers incidents from April 2021 onwards. We recognise the case of 
Ms  Merton,  and  Mr  Hurst,  occurred  prior  to  this,  so  we  have  appointed  a  clinician  to 
undertake a review of historic action plans to ensure actions are completed and evidence 
is available. This person commenced in post in November 2021, however they have been 
redeployed to front line services as a result of the current COVID wave, and we hope 
they will be available to return back to this important work during January 2022. This work 
will continue until we are assured of prior action plan completion.  

I  hope  this  letter  offers  you  assurance  that  we  have  implemented  a  new  system  to 
address the concerns and provide greater oversight and assurance in the future. I also 
hope that our work to review action plans prior to the new process also offers assurance 
to you.   

One again, please may I offer my condolences to the loved ones of Ms Hurst and my 
apologies for the concerns you have identified on this and other occasions.  

Should  you  require  any  further  information  or  evidence  of  the  actions  outlined  above 
, Associate Director of Quality Assurance. 
please contact either myself or 

Yours sincerely 

Prif Weithredwr 
Chief Executive

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