Jonathan Fry
16 May 2016 · Coroner Kate Thomas · Mid Kent and Medway
A similar concern from this report was raised again 2 times later. See the linked reports.
The coroner's concerns
1. lack of senior consultant review
“There was no Senior review by a Consultant from admission to the time of his death and was no locum cover”
2. lack of daily test result review
“There was no daily review of test results and no consideration given to instances where tests had not been performed or consoderation given to to the reasons why”
3. inconsistent and incomplete medical records
“Medical records were inconsistent and / or incomplete leading to a lack of clarity as to reviews and care plan”
Linked reports
Closely relatedConfidence 0.90 · high
This report
“Medical records were inconsistent and / or incomplete”
Later report
“The next of kin was incorrectly recorded on Mr [name redacted] medical records”
Identical hazardConfidence 0.90 · high
This report
“Medical records were inconsistent and / or incomplete leading to a lack of clarity as to reviews and care plan.”
Later report
“At the inquest it was clear that the standard of record keeping by the medical staff was poor”
Responses
No published response was found on judiciary.uk.