Prevention of Future Deaths reports · 2015

Karen O’Brien

Regulation 28 report to prevent future deaths, written 15 Jul 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report15 Jul 2015
DeceasedKaren O’Brien
CoronerRoy Palmer
Coroner areaLondon (City)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
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.

H.M. Coroner, City of London 

City of London Coroner’s Office 
Walbrook Wharf, 78-83 Upper Thames Street, London EC4R 3TD 

Coroners & Justice Act 2009; The Coroners (Investigations) Regulations 2013 No. 1629 
REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

NOTE: This form is to be used after an inquest. 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  Chief Executive, First Response Team, South Essex 

Partnership University NHS Foundation Trust  

2.  Chief Executive NICE 

1  CORONER 

I am Dr Roy Palmer, assistant coroner for the City of 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, No. 1629. 

3 

INVESTIGATION and INQUEST 

On 21st April 2015 we commenced an investigation into the death of 
Karen O’Brien born 27th April 1968. The investigation concluded at the 
end of the inquest on 13th July 2015. The conclusion of the inquest was 
that Karen O’Brien killed herself. The medical cause of death was 
Multiple Injuries. 

4  CIRCUMSTANCES OF THE DEATH 

Karen O’Brien suffered from chronic pain and depression. A general 
practitioner (GP) from London Road Surgery had treated her with 
sertraline and with paroxetine as well as with pain-killing medication. On 4 
November 2014 he referred her to the mental Health Crisis Team 
because of depression and anxiety with somatization and because she 
admitted to self-harm thoughts. She was also a carer for her father. The 
GP asked if the Mental Health Crisis Team could see her. 

On 10 November a community mental health nurse from the First 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Response Team of South Essex Partnership University NHS Foundation 
Trust (SEPT NHS) replied by letter to the GP that “based on the 
information received, we have clinically determined a mental health face 
to face assessment is not required at this stage”, stating that NICE 
Guidelines recommended that patients are offered two different types of 
anti-depressants before being referred to secondary mental health 
services. (Emphasis added) 

On 18th March 2015 the patient registered with Robert Frew Medical 
Partners and was referred to hospital on 24th March for assessment of a 
breast lump. On 21st April 2014 Karen O’Brien jumped into the path of an 
underground train at Liverpool Street station. 

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.  –  

It is difficult to understand how there can be a clinical determination by 
SEPT without more inquiry and, preferably, some face-to-face 
assessment of the patient by a mental health professional. 

The NICE guidance is stated to be a recommendation. It must therefore 
be presumed not to be applied slavishly without careful assessment. The 
patient’s GP had asked for her to be seen. On what basis did SEPT 
decide to override the GP’s request? 

If the NICE Guideline has been accurately reported in SEPT’s letter to the 
GP, I respectfully invite NICE to reconsider the guideline.  

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 11 September 2015. I, the coroner, may extend 
the period if you so request. 

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 Persons: 

 (father-in-law) 

The London Road Surgery, Wickford, Essex 
Robert Frew Medical Partners, Wickford, Essex 

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 

 15th July 2015 

Coroner

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