Anthony Bernard Mcormick
8 Oct 2013 · Coroner Nigel Meadows · Manchester City
The coroner's concerns
1. failure to admit urgently after abnormal blood tests
“When the results of the blood tests taken at Macclesfield Hospital on 27 January 2011 were received this should have resulted in an urgent admission to hospital and further investigations undertaken to establish the source of the symptoms. This did not happen and suggests failures in communication and senior clinical review and appreciation of the significance of the presenting symptoms.”
2. failure to appreciate seriousness of condition
“There was a significant failure to appreciate the seriousness of the condition, the need for urgent treatment and associated raised mortality risks upon the receipt of the results of the CT scan on 28 February 2011 showing the presence of multiple liver abscesses and gallstones. These are all factors which it would be reasonable to expect senior clinicians to appreciate and plan care accordingly.”
3. failure to refer for Cholecystectomy
“Upon receiving advice about the need for a Cholecystectomy after the HPB MDT on 9 March 2011 there was a significant failure to ensure that a timely and appropriate referral was made to a specialist Hepato-Biliary surgeon.”
4. inappropriate GP referral request
“Requesting the GP to make a formal referral at that stage was inappropriate and caused significant further delay in appropriate treatment. His care was being led by a senior and experienced Consultant.”
5. inconsistent antibiotic therapy
“Throughout the course of his clinical care at Macclesfield Hospital there was 4 failure to ensure that he consistently received appropriate antibiotic therapy without avoidable gaps in treatment.”
6. delayed Cholecystectomy and inadequate antibiotic cover
“The deceased had not been referred in a timely and appropriate manner for the Cholecystectomy following the HPB MDT on 9 March 2011 and was not provided with appropriate antibiotic cover to ensure resolution of his liver abscesses”
Responses
No published response was found on judiciary.uk.