Prevention of Future Deaths reports · 2025

Ann Cotgrove

Regulation 28 report to prevent future deaths, reference 2025-0103, written 21 Feb 2025. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Feb 2025
Reference2025-0103
DeceasedAnn Cotgrove
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 3rd of May 2022 I commenced an investigation into the death of Ann Margaret Cotgrove    
(DOB 10.08.51 DOD 03.05.22). The investigation concluded at the end of the inquest on the 20th 
of February 2025.  The cause of death was recorded as being due to 1(a) Peritonitis , Acute 
Liver Failure and Bronchopneumonia 1b Gall Bladder Perforation 1c Endoscopic retrograde 
cholangiopancreatography due to obstructive jaundice and the conclusion of the inquest was that 
the death was due to medical misadventure. 

4 

CIRCUMSTANCES OF THE DEATH 

The circumstances of the death are that Miss Cotgrave had been admitted to Glan Clwyd 
Hospital on the 31st of March 2022 and was being investigated to establish the cause of her 
jaundice. She did not undergo a required ERCP until the 19th of April and on the 22nd of April was 
found to have sustained a perforation which is likely to have occurred in the course of that 
procedure. By that time she was too unwell to undergo reparative surgery and she passed away 
on the 3rd of May 2022.  

The delay in her undergoing the ERCP was due (inter alia) to the consultant gastroenterologist 
requesting that advice from tertiary centre in Liverpool be obtained prior to the procedure due to 
a suspicion of malignancy. He was subsequently informed that advice had been received 
indicating the ERCP should be undertaken at Glan Clwyd and he therefore proceeded.  

Whilst there is no reason to doubt the veracity of the consultant’s evidence, that advice from the 
tertiary centre had been sought, there is no documented evidence in relation this. 

5 

CORONER’S CONCERNS 

During the course of the inquest the evidence revealed the following matter 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 MATTER OF CONCERN is as follows.  – 

That there was no record of any discussions which took place been Glan Clwyd and the tertiary 
centre and no formal documented process in relation to such referrals and the subsequent 
advice which was provided and thereafter acted upon. 

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

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 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 
18th April 2025 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 21st February 2025 

Signature 
Senior Coroner for North Wales (East and Central) 

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

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 Betsi Cadwaladr University Health Board (PDF)
Bloc 5, Llys Carlton, Parc BusnesLlanelwy, 
Llanelwy, LL17 0JG 

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

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

Ein cyf / Our ref: I
Eichcyf / Your ref: 
: 03000 840135 
Gofynnwch am / Ask for: 
E-bost / Email: 
Dyddiad / Date: 16 April 2025  

John Gittins  
HM 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 
Ann Margaret Cotgrove 

I  write  in  response  to  the  Regulation  28  Report  to  Prevent  Future  Deaths  dated  21 
February 2025, issued by yourself to Betsi Cadwaladr University Health Board, following 
the inquest touching upon the death of Mrs Cotgrove.  

I would like to begin by offering my deepest condolences to the family of Mrs Cotgrove. 

As you know, the Board is committed to building a learning and improving organisation 
and  we  take  all  Prevention  of  Future  Death  Notices  very  seriously.  In  the  notice,  you 
highlighted your concerns that whilst expert advice from a specialist tertiary hospital had 
been sought, there was no documented process or evidence in relation this 

The  issues  identified  in  your notice  were  shared  with the  clinical team  involved  in  this 
case immediately after the inquest for reflection and learning.  

The learning contained in your notice has also been shared with our Reducing Avoidable 
Mortality Group at its meeting in April 2025. This group leads on our work across North 
Wales to learn from deaths and reduce avoidable mortality with representatives attending 
from all services.  

However,  we  felt  that  the  absolute  necessity  for  the  documentation  of  discussions 
between  clinicians,  particularly  when  seeking  opinion  from  a  tertiary  centre,  is  an 
important learning point to widely share.  

As  such,  we  have  developed  a  case  summary  presentation  which  our  Central  Health 
Community Medical Director will share across their services through clinical governance 
meetings. This will help ensure all services learn from this case. We will also be sharing 
the case summary with our other two acute hospital Medical Directors for wider cascade.  

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 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 In  addition,  it  is important  we  recognise  the challenges  our clinical  staff  have  with  our 
current  record  keeping  arrangements,  which  includes  some  paper  records  and  some 
electronic records (which can be disjointed). As you know, the Health Board is actively 
progressing an integrated digital solution and we believe this will significantly improve the 
quality of patient records – the Health Board is at the forefront of this work across Wales. 
We have developed an Outline Business Case and this is due for approval at our Board 
in June 2025, before submission to the Welsh Government in July 2025. 

I hope this letter sets out for you the actions that we are taking to address the concerns 
you raised.  

I would be happy to meet with you and discuss our work to improve patient safety in more 
detail or provide further information and assurance should that be helpful.  

Once again, I offer my deepest condolences to the family of Mrs Cotgrove for their loss. 

Yours sincerely 

Cyfarwyddwr Gweithredol Nyrsio a Bydwreigiaeth 
Executive Director of Nursing and Midwifery 

cc  

 Deputy Director for Legal Services

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