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recurance

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Max Haigh

1 Mar 2016 · Coroner Philip Holden · West Yorkshire (East)
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The coroner's concerns

  1. 1. inadequate surgical notes

    “Following surgery the surgeon prepared a note of his operation for the medical records. it was anticipated that [the deceased] may, in the future, require further surgery. The note of the surgery was unsatisfactory and failed to set out:- (a) The position of the ventricular septal defect ("VSD") and how it was enlarged; (b) A full description of the VSD; (c) The position of the tricuspid valve; (d) The techniques that were used by the surgeon himself.”

Responses

No published response was found on judiciary.uk.

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error