Prevention of Future Deaths reports · 2022

Aleksandra Markowska

Regulation 28 report to prevent future deaths, reference 2022-0303, written 29 Sep 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report29 Sep 2022
Reference2022-0303
DeceasedAleksandra Markowska
CoronerNadia Persaud
Coroner areaEast London
CategorySuicide (from 2015)
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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

MISS N PERSAUD 
HIS MAJESTY’S CORONER 

EAST LONDON 

Walthamstow Coroner's Court, Queens Road Walthamstow, E17 8QP 

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

Ref: 15428988 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1. 

NHS England 

1 

CORONER 

I am Nadia Persaud area coroner for the coroner area of East 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. 
http://www.legislation.gov.uk/ukpga/2009/25/schedule/5/paragraph/7 
http://www.legislation.gov.uk/uksi/2013/1629/part/7/made 

3 

INVESTIGATION and INQUEST 

On 13 October 2021 I commenced an investigation into the death of Ms Aleksandra 
Markowska age 41 years. The investigation concluded at the end of the inquest on 27 
September 2022. The conclusion of the inquest was a narrative conclusion: 

Alexandra took her own life whilst suffering from pregnancy related depression and 
anxiety.  She had suffered from severe symptoms for around four months.  Despite 
seeking help from a number of sources she did not receive a review by a perinatal 
psychiatrist. 

4 

CIRCUMSTANCES OF THE DEATH 

Between 17 June 2021 to the 21 July 2021 Alexandra had multiple contacts with the 

1 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 British Pregnancy Advisory Service (BPAS).  She presented to the service with distress, 
agitation, anxiety and conflict over her pregnancy.  On the 10 July 2021 a treatment unit 
manager identified a concern in relation to Alexandra's mental health and her mental 
capacity.  The treatment unit manager considered that Alexandra required a mental 
health assessment.  There was no direct access to a perinatal psychiatrist, so a 
safeguarding referral was made.  The outcome of the referral is unknown. Alexandra did 
not undergo any review by a perinatal psychiatrist and she did not have a full capacity 
assessment undertaken.  She expressed conflicting views about her pregnancy up until 
the termination of pregnancy took place on the 17 July 2021.   
On the 1 July 2021 Alexandra presented to her GP with anxiety, depression and 
insomnia relating to her pregnancy.  She was referred to the mental health services and 
a review by a psychiatrist was requested.  Alexandra did not receive an assessment by 
a psychiatrist.  
Within the mental health trust, Alexandra received contact from multiple teams but did 
not receive a full mental health assessment or a full assessment of her risk to self.  
There was an absence of joined up working and an absence of psychiatric attention.   
On the 30 September 2021 Alexandra was found unresponsive at the bottom of 21 
Gardner Close, E11.  Resuscitation was attempted by the emergency services, but sadly 
her life was pronounced extinct on scene.   The evidence indicates that she had jumped 
  Police found no evidence of third party involvement.   

There were no substances found on toxicology that would have impaired Alexandra's 
ability to form an intention to take her own life.  A note had been sent indicating her 
intention to take her own life. 

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:  

The British Pregnancy Advisory Service (BPAS) is a charity whose services are often 
commissioned by the NHS.  As a charity, BPAS does not have direct access to NHS 
perinatal psychiatrists. Referrals would have to be made either via the patient’s GP or 
via an unwieldy safeguarding concern (as happened in this case).  Referrals via the GP 
are not possible where the patient does not wish their identity to be revealed.   

It is a matter of concern that there is no direct access for BPAS patients who are 
suffering from pregnancy related mental health decline, to peri-natal psychiatry teams.  

Direct and confidential access to peri-natal psychiatry teams may reduce the risk of 
future deaths.    

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 23rd November 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 

2 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons the family of Ms Markowska, to the other interested persons to the Inquest, the 
CQC and to the local director of public health who may find it useful or of interest. 

I am also under a duty to send a copy of your response to the Chief Coroner and all 
interested persons who in my opinion should receive it.   

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. 

9 

29 September 2022      

  G N Persaud 

3

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