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recurance

Brenda Elmer

14 Aug 2020 · Coroner Penelope Schofield · West Sussex

The coroner's concerns

  1. 1. acquisition of Listeria infection from contaminated sandwich

    “Mrs [name redacted] attended St Richards Hospital, Chichester, for elective surgery. She had attended the hosptial for a Pre Operation Assessment on 25th April 2019 and was admitted for her surgery on 30th April 2019. Whilst attending the hospital she acquired a Listeria infection from a chicken sandwich although this was not know at the time. Mr [name redacted] did not live in Sussex and following her treatment she returned home to Kent on 3rd May 2019.”
  2. 2. lack of legal requirement to share Listeria isolates

    “During the course of the Inquest evidence was given by the representative of Public Health England that there was no legal requirement for Private Laboraties who identifiy Listeria in food to share the Listeria isolate with PHE or indeed keep this isoloate for any period of time. If a problem is subsequentlhy identified 2 by PHE then it makes it particulary difficult to check if particular products have been implicated”
  3. 3. lack of legal requirement for hospitals to share Listeria isolates

    “Similary there is no legal requirement of Hospital Trusts to send in Listeria isolates when Listeria has been identified. This therefore does not allow PHE to match particular strains and identify outbreaks which are connected earlier.”

Responses

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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.

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