Prevention of Future Deaths reports · 2022

Van Tuyen

Regulation 28 report to prevent future deaths, reference 2022-0058, written 22 Feb 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report22 Feb 2022
Reference2022-0058
DeceasedVan Tuyen
CoronerJonathan Stevens
Coroner areaInner North London
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.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  Secretary of State for the Department Health & Social Care,  39 Victoria Street 

Westminster,  London SW1 H 0EU 

2.  Chief Executive, Barts Health NHS Trust,  Whitechapel Road, Whitechapel, 

London,  E1  1FR 

3.  NHS England London,  Skipton House,  80 London Road,  London,  SE1  6LH 

CORONER 

I am JONATHAN STEVENS, Assistant Coroner, for the coroner area of Inner North 
London 

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 31 st August 2021  Assistant Coroner Stevens commenced an investigation into the 
death of VAN THAI TUYEN [age 96). 

The investigation concluded at the end of the inquest on 2nd  February 2022. 

The conclusion of the inquest was that death was a consequence of neglect namely a 
failure to identify that a nasogastric tube had been misplaced before commencing 
feeding. 

The medical cause of death was: 

1 (a) cavitating necrotising pneumonia 

(b) misplaced nasogastric tube 

2. Cerebrovascular disease, hypertension, diabetes mellitus, Parkinson's disease 

(b)  CIRCUMSTANCES OF THE DEA TH 

Mr Van Thai Tuyen was admitted to the Royal London Hospital on  1st  August 2021  for 
treatment of a stroke.  A nasogastric tube was inserted to administer medication and 
food, due Mr Tuyen being assessed as having an unsafe swallow.  Despite an x-ray 
showing that the nasogastric tube had been misplaced into his right lung the tube was 
used to administer approximately 300ml of liquid feed.  This caused the cavitating 
necrotising pneumonia from which he died. 

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 could 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)  Using a misplaced nasogastric tube is recognised as a 'never event', namely an 

event which is wholly preventable and should never happen. 

(2)  The court heard evidence at the inquest that an NHS improvement patient 

safety alert issued in 2016 identified that between 2011-2016 there had been 95 
incidents of misplaced nasogastric tubes used to administer fluids or medication, 
32 of which resulted in death. 

(3)  The court heard that there had  been Barts NHS Trust had had at least 7 

incidents relating to misplaced nasogastric tube since 2012. 

(4)  The court heard that the use of misplaced nasogastric tubes to administer 
liquids or medications continues to take place in Trusts across the country 

(5)  The court heard that there is no unified approach to address the on going issue 

of avoidable deaths caused by using misplaced nasogastric tubes. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and  I believe you AND/OR 
your 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 19th April 2022. 

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 

, grandchildren of the 

deceased. 

I am also under a duty to send the Chief Coroner a copy of your response. 

I may also send a copy of your response to any other person who I believe may find it 
useful or of interest 

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 

22nd  February 2022  SIGNED 

.. 

V 

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 Department of Health and Social Care (PDF)
From Maria Caulfield MP 
Parliamentary Under Secretary of State  
Department of Health and Social Care 

39 Victoria Street 
London 
SW1H 0EU 

Tuesday 29th November 2022 

Jonathan Stevens 
Assistant Coroner 
Inner North London 
St Pancras Coroner’s Court 
Camley Street 
London N1C 4PP 

Dear Mr Stevens,  

Thank you for your letter of 22 February 2022 about the death of Mr Van Thai Tuyen.  I am 
replying as Minister with responsibility for Health and Secondary Care.    

Firstly, I would like to say how saddened I was to read of the circumstances of  Mr Tuyen’s 
death and I offer my sincere condolences to his family and loved ones.  The circumstances 
your report describes are very concerning and I am grateful to you for bringing these matters 
to my attention.  

In preparing this response, Departmental officials have made enquiries with NHS England and 
the Care Quality Commission (CQC). 

Since  NHS  England  issued  the  2016  Patient  safety  alert  ‘Nasogastric  tube  misplacement: 
continuing risk of death and severe harm’ and accompanying resources, they have worked 
with  partners  across  the  healthcare  system  to  provide  additional  support  for  local 
implementation of this guidance.  This includes funding the Royal College of Radiologists to 
provide  eLearning  in  x-ray  interpretation  of  nasogastric  tube  placement,  working  with  the 
British  Association  for  Parenteral  and  Enteral  Nutrition  who  published  an  easy  reference 
version of key nasogastric safety checks, and working with the Nursing and Midwifery Council 
who added nasogastric placement to its core standards of proficiency for registered nurses. 

In October 2019, the Healthcare Safety Investigation Branch (HSIB) launched an investigation 
into nasogastric tubes and how previously identified safety improvements for the placement 
of these tubes are put into practice.  HSIB published their report in December 2020, which 
included a recommendation that NHS England and the Department of Health and Social Care 
identify  the  process  by  which  the  NHS  can  commission  necessary  research  to  support 
improvements  in  patient  safety,  including  research  to  confirm  nasogastric  tube  placement.  
Implementation of the learning and advice from the HSIB report within the health system is 
ongoing. 

To support this, and following an open competition, the Department has awarded £25 million 
of  funding  over the  next  five years  via the  National  Institute for  Health and  Care  Research 
(NIHR) for research on patient safety to improve the safe delivery of health and care.  The 
funding is for six NIHR Patient Safety Research Collaborations (PSRCs) across England to 
help  improve  understanding  and  resolution  of  patient  safety  challenges.    The  PSRCs  will 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 From Maria Caulfield MP 
Parliamentary Under Secretary of State  
Department of Health and Social Care 

39 Victoria Street 
London 
SW1H 0EU 

undertake  high-quality  translational,  applied  and  health  services  research  on  patient  safety 
that addresses strategic patient safety challenges within the health and care system, aligned 
with NHS England’s National Patient Safety Strategic Research Needs 2022/23.   Crucially, 
the PSRCs’ work will include research into the reduction of never events.   

I hope this response is helpful. Thank you for bringing these concerns to my attention.  

Kind regards,  

 MARIA CAULFIELD

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