Rita Giles
11 Jul 2018 · Coroner Veronica Hamilton-Deeley · Brighton & Hove
A similar concern from this report was raised again 1 time later. See the linked reports.
The coroner's concerns
1. unnecessary transfers without supporting paperwork
“Unnecessary transfers to and from the Princess Royal Hospital with no supporting paperwork”
2. non adherence to transfer policy
“The Trust's own Transfer Policy not adhered too in any respect”
3. delayed ERCP procedure
“Delay in her endoscopic retrograde cholangiopancreatography ERCP until she was so ill that it needed to be done on the CEPOD list under general anaesthetic and required ICU support”
4. limited ERCP capacity
“At Inquest it was explained to me that there are only three people in the Trust that can carry out ERCP work, they have one list each a week, lists are only on Mondays, Wednesdays and Fridays”
5. inadequate urgent access to ERCP slots
“The lists seem to be booked well in advance so there is little or no resource for the patient who comes in as Miss [name redacted] did with an urgent requirement”
6. inappropriate initial hospital location
“From the Inquest it appeared that the Princess Royal Hospital was not the right place for her to be, there is argument to suggest that she should have been transferred early to the Royal Sussex County Hospital in Brighton and presumably if she needed urgent treatment she could have had it”
Linked reports
Closely relatedConfidence 0.90 · high
This report
“(1) Unnecessary transfers to and from the Princess Royal Hospital with no supporting paperwork.”
Later report
“(1) Unnecessary and inappropriate transfers between the Royal Sussex County Hospital, the Princes Royal Hospital and the Royal Sussex County Hospital.”
Responses
No published response was found on judiciary.uk.