Prevention of Future Deaths reports · 2015

Madhumita Mandal

Regulation 28 report to prevent future deaths, written 8 Dec 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report8 Dec 2015
DeceasedMadhumita Mandal
CoronerSelena Lynch
Coroner areaLondon (South)
CategoryCommunity health care and emergency services related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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In the South London Coroner’s Court
Inquest touching the death of Madhumita Mandal

Report to Prevent Future Deaths (Coroners (investigations) Regulation 28)

THIS REPORT IS BEING SENT TO:

1. Croydon Health Services
2. Virgin Care Wandle LLP
3. Croydon Clinical Commissioning Group

1 | CORONER

| am Selena Lynch senior coroner for the coroner area of South London

2 | CORONER’S LEGAL POWERS

| 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 ie" September 2013 the Senior Coroner Dr Roy Palmer (now retired) commenced
an investigation into the death of Madhumita Mandal . | took conduct of the investigation
in April 2014.

The investigation concluded at the end of the inquest on 23 September 2015. The
conclusion of the inquest was that Madhumita Mandal died from multiple organ failure
due to sepsis due to ruptured endometriotic ovarian cyst (recently treated with
laparotomy). | recorded a narrative conclusion as follows: Mrs Mandal suffered from
an endometrial cyst and was awaiting surgical removal. She became unwell and
attended Croydon University Hospital at about 7.20 a.m. on 7" September 2013. There
were several cumulative delays in the Urgent Care Centre and Emergency Department
in assessing and treating her, the Registrar did not appreciate the seriousness of her
condition in spite of concerns raised by the junior doctor, and the consultant did not
supervise his juniors or make himself aware of what was happening in the department.
There were missed opportunities to take urgent steps that may have prevented Mrs
Mandal’s death, but the evidence does not disclose whether her death would have been
prevented by earlier appropriate assessment and treatment.

4 | CIRCUMSTANCES OF THE DEATH

Please see the narrative conclusion set out in paragraph three, which sets out the
circumstances leading to the death. The subject of this report relates to events in the
Urgent Care Centre, as set out in paragraph 5.

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 MATTER OF CONCERN is follows:-
Mrs Mandal was taken to Croydon University Hospital by her husband. Virgin Care was
contracted by the Croydon Clinical Commissioning Group to provide urgent care

services, and to stream adult patients arriving at the emergency department. A
streaming model was followed by a receptionist who had no medical training and who
performed no medical observations. This led to a delay of about an hour before Mrs
Mandal was seen by any qualified healthcare professional, by which time her condition
was critical.

The streaming model had been approved and commissioned in the contract as
recommended by an NHS body called the Emergency Care Intensive Support Team.
The system at Croydon has changed since Mrs Mandal's death but concerns remain
about the level of qualification for assessment of patients, and there may be lessons for
other Trusts who contract out the provision of urgent care.

Mrs Mandal’s’ death also raises questions about the use of ambulance services. A
difference in assessment of patients based upon their mode of transport to the
emergency department may encourage patients to err on the side of calling an
ambulance.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | 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 an February 2016. |, 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

| have . to the Chief Coroner and to the following Interested
Person: (for the family)

| have also sent it to Sir Bruce Keogh, National Medical Director, NHS England, who
may find it useful or of interest.

| 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.

DATE 8" December 2015 SIGNED Vit AALY “yt “270

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