Prevention of Future Deaths reports · 2022

David Hulme

Regulation 28 report to prevent future deaths, reference 2022-0199, written 27 Jun 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report27 Jun 2022
Reference2022-0199
DeceasedDavid Hulme
CoronerIan Arrow
Coroner areaPlymouth, Torbay and South Devon
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedUniversity Hospitals Plymouth 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.

OFFICIAL 

Ian  M Arrow Her Majesty's Senior Coroner 
for the  County of  Devon 
Plymouth,  Torbay and  South  Devon  Coroner Service 

REGULATION 28  REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS  BEING  SENT TO:  Chief Executive,  University Hospitals Plymouth, NHS 
Trust, Chief Coroner 

CORONER 

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

2 

CORONE~SLEGALPOWERS 

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. u k/u kpga/2009/25/schedu le/5/parag raph/7 
http://www. legislation. gov. uk/uksi/2013/1629/part/7 /made 

3 

INVESTIGATION and  INQUEST 

On  27 June 2022  I heard an  Inquest touching  the  death of David Anthony  Hulme. 

I recorded  a narrative conclusion,  namely:-

The deceased had  a history of chest symptoms.  In  particular he had  a right pulmonary abscess. 

On  12  June  2020  he  underwent  a  right  thoracotomy  for  pneumonectomy.  Histology  by  a 
regional  hospital pathologist confirmed this as  sarcoidosis. 

the 
It  became  clear 
Histopathologist  referred  the  case  to  The  National  Centre  of  Excellence  for  lung  conditions,  a 
second  Hospital Trust. 

the  deceased  was  deteriorating 

On  25  January  2021 

further. 

On  1 February 2021  the deceased's wife reported worsening symptoms. 

On  10 February 2021  the second Trust indicated suspected  B Cell  Lymphoma. 

The samples were sent for a third opinion. 

On  15 February 2021  a supplemental report was  issued  by the third Trust. 

On  16 February 2021  a supplemental  report was  issued  by the second  trust. 

All this time the  deceased remained on  the Intensive Care Unit. 

The further opinions indicated  a condition  known  as  Lymphoma. 

The deceased was treated  for Lymphoma. 

The deceased's condition deteriorated. 

A discussion not to  resuscitate was  had on  3 March 2021. 

The  deceased  died  on  6  March  2021.  His  cause  of death  was  Lymphoma  a  naturally  occurring 
condition. 
I heard  evidence from  a Consultant Pathologist that her Pathology Department was  under 
si~nificant pressure of work and  in  her opinion was  understaffed. 

 OFFICIAL 

I heard  evidence from the Hospital Trusts Pathology Manager that he  had  prepared a business 
case for the additional appointments of Consultants. 

4 

CIRCUMSTANCES OF THE DEATH 
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.  -

I am concerned that the  Pathology Department remains significantly under resourced. 

I ask you  please to:-
(1)  Review the Consultants staffing  levels in  the  Pathology Department particularly those 
Consultants dealing with Thoracic work so as to  ensure timely and  accurate diagnosis of 
conditions at this  regional  centre. 

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. 

YOUR RESPONSE 

You  are under a duty to  respond  to this  report within  56  days of the date of this  report,  namely by 
22 August 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. 

I have also sent it to  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 y6ur response  by the Chief Coroner. 

9 

Dated  27 June 2022 

Signature 

/ 
/,' 
,.Y/ 
c·. 
Ci
~··  L·-··•--.J 
·enior Coroner 

, 

I M Arrow, 
Plymouth, Torbay and  South  Devon

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 NHS University Hospitals Plymouth (PDF)
Professor Mark Hamilton MBBS BSc FRCA FFICM 
Chief Medical Officer 
Department of Clinical Management, Level 07 
University Hospitals Plymouth NHS Trust 
Derriford Road 
Plymouth  PL6 8DH 
Tel. 01752 439488 
E Mail : markhamilton@nhs.net 
www.plymouthhospitals.nhs.uk 

13th July 2022 

Mr I Arrow 
HM Coroner 
1 Derriford Business Park 
Breast Road 
Plymouth  PL6 5QZ 

Sent by e mail to HMCoroner@plymouth.gov.uk 

Dear Mr Arrow 

Re :  

Inquest touching the death of David Hulme ; Inquest Date – 27/06/2022 

At the conclusion of the above referenced inquest, you determined that under the powers granted to you 
by paragraph 7, schedule 5 of the Coroner and Justice Act 2009 and Regulations 28 and 29 of the Coroner 
(Investigations) Regulations 2013 that you would write to University Hospitals Plymouth NHS Trust (UHP) 
with a Preventing Future Deaths Report. 

We have now received that report and note your concerns are as below: 

“I am concerned that the Pathology Department remains significantly under resourced. 

I ask you please to: 
(1)  Review  the  Consultants  staffing  levels  in  the  Pathology  Department  particularly  those  Consultants 
dealing with Thoracic work so as to ensure timely and accurate diagnosis of conditions at this regional 
centre” 

As part of the inquest process UHP provided you with a copy of the Root Cause Analysis Report (RCA) 
which identified the need for additional Consultant resource within the Pathology Department to which your 
concern is directed.  

The  evidence  submitted  both  within  the  RCA  and  via  a  further  report,  authored  by  the  Pathology 
Operations Manager, confirmed that the business case to appoint further Consultants into the Pathology 
Department  had  been  approved  with  funding  allocated  to  this  end.  It  was  stated  that  the  recruitment 
process would commence as soon as possible. 

Working in Partnership with the Peninsula Medical School 

Chairman: Richard Crompton 

Chief Executive: Ann James 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I  can  confirm  that  UHP  have  approved the  funding  for  4  x  Consultant  Pathologist  posts  and  whilst  we 
cannot  guarantee a date  that  these  posts  will  be  filled,  we hope to recruit  into these posts  as soon  as 
possible and are in an active recruitment phase. 

We  would  ask  you  to  note  however  that  there  is  a  national  shortage  of  suitably  qualified  clinical  staff 
practicing in this field and thus whilst we shall pursue these appointments with our best endeavours the 
recruitment may be a protracted process. 

Due to this, I would like to assure you that we have taken additional action and are still reviewing mitigating 
processes we can take to improve the system within which we operate to further reduce the risk of harm 
occurring  to  patients.  This  is  as  outlined  within  the  evidence  already  submitted  as  part  of  the  inquest 
process,  with  governed  outsourcing  and  working  with  system  partners  across  Devon  to  look  at  all 
histopathology resource in our respective organisations to understand if a system solution is possible. We 
are also working with the Pathology network to try and find additional workforce resilience across Devon 
and Cornwall. 

We  trust  this  response  can  assure  you  of  our  commitment  to  providing  a  suitably  staffed  Pathology 
Department and our commitment to the safety of all patients within the whole South West region.  

Yours sincerely 

Professor Mark Hamilton 
Chief Medical Officer for UHPNT 
Visiting Professor University of Plymouth Faculty of Health 

Page 2 of 2

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