Prevention of Future Deaths reports · 2024
Regulation 28 report to prevent future deaths, reference 2024-0428, written 29 Jul 2024. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 29 Jul 2024 |
|---|---|
| Reference | 2024-0428 |
| Deceased | Scott Punshon |
| Coroner | Leslie Hamilton |
| Coroner area | Durham and Darlington |
| Category | Road (Highways Safety) related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | 1 |
Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.
Regulation 28: REPORT TO PREVENT FUTURE DEATHS NOTE: This form is to be used after an inquest. REGULATION 28 REPORT TO PREVENT DEATHS THIS REPORT IS BEING SENT TO: 1 1 CORONER I am JR Leslie HAMILTON, Assistant Coroner for the coroner area of County Durham and Darlington 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 23/08/2023 13:37an investigation was commenced into the death of Scott Andrew PUNSHON 16/06/1987 00:00:00. The investigation concluded at the end of the inquest on 30/05/2024 11:00. The conclusion of the inquest was that Scott Andrew Punshon was a 36 year old man who was found deceased, lying on the road (the A689 Road near Howden Le Wear) on the 12th August 2023. He was walking home from Crook in the early hours, having spent the evening with friends drinking. The collision investigation and the injuries identified at post mortem showed that he had been lying in the road when the car struck him. Toxicology showed a blood alcohol of 280mg/100mls and evidence that he had consumed cocaine and cannabis.. 4 CIRCUMSTANCES OF THE DEATH Scott Andrew Punshon was a 36 year old man who was found deceased, lying on the road (the A689 Road near Howden Le Wear) on the 12th August 2023. He was walking home from Crook in the early hours, having spent the evening with friends drinking. The collision investigation and the injuries identified at post mortem showed that he had been lying in the road when the car struck him. Toxicology showed a blood alcohol of 280mg/100mls and evidence that he had consumed cocaine and cannabis. 5 CORONER’S CONCERNS During the course of the investigation my inquiries 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: (brief summary of matters of concern) On the 13th September 2023, on behalf of Durham County Council, you carried out a site investigation (Fatal Accident Report M/T/R11/23) which identified issues with road markings, signage and lighting. You made recommendations that these should be addressed by the DCC Technical Services personnel. 6 ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe you (and/or Regulation 28 – After Inquest Document Template Updated 30/07/2021 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 September 23, 2024. 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. COPIES and PUBLICATION 8 I have sent a copy of my report to the Chief Coroner and to the following Interested Persons I have also sent it to 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 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 Dated: 29/07/2024 JR Leslie HAMILTON Assistant Coroner for County Durham and Darlington Regulation 28 – After Inquest Document Template Updated 30/07/2021
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.
Contact: Direct Tel: email: Your ref: Our ref: JR Leslie Hamilton Assistant Coroner for County Durham and Darlington HM Coroner’s Office Fourth Floor Civic Centre North Terrace Crook DL15 9ES By email 28th August 2024 Dear Mr Hamilton Fatal Road Traffic Accident Saturday 12th August 2023 at 01:00hours - A689, Howden-le-Wear. I write regarding the attached correspondence dated 29th July 2024 regarding the unfortunate fatal accident which took place on the A689 near Howden le Wear on the 12th August 2023. As a result of the accident investigation three observations/recommendations were raised by the investigation officers which have also been highlighted in your report. I can confirm following receipt of the fatal accident report council officers took the following actions: • Street Lighting columns 333 and 334 – All overgrown vegetation impacting on the illumination of the highway at these 2 locations was trimmed back: • Road Markings – All road markings in the vicinity of the accident have been refreshed: and • Speed limit signage – The sign has been realigned and any vegetation in the vicinity of the sign which could be considered obscuring the view of the sign have been cut back. Neighbourhoods and Climate Change Durham County Council, St John’s Road, Meadowfield, Durham. DH7 8XL Main Telephone 03000 26 0000 Text Messaging Service 07860 093 073 www.durham.gov.uk Page 2 of 2 I can confirm we continue to assess the condition of the highway as part of our scheduled safety inspections as identified in the councils Highway Safety Inspection Manual which is aligned to the National Code of Practice for Well Maintained Highway Infrastructure and any issues meeting the investigatory level will be identified for remedial action. I trust the above is acceptable, but should you wish to discuss this matter in greater detail please do not hesitate to contact Paul Anderson, Strategic Highways Manager , by email at Yours sincerely Head of Highways Copy , Strategic Highways Manager
See every Prevention of Future Deaths report matching Road (Highways Safety) related deaths, and how often a new one appears.
What would an alert for this have sent me? Search the full text
Free to try — the preview shows the real matches and how many arrived in the last 12 months. Your first email alert is free.
These reports are published by the Chief Coroner's office at judiciary.uk and are © Crown copyright. The text here is reproduced from the published PDF so it can be searched. If something on this page is wrong, or you are a person named in it and want it reviewed, email drcjar@gmail.com and we will act promptly.