Peter Pettit
2 Apr 2026 · Coroner Darren Stewart · Suffolk
The coroner's concerns
1. inadequate record keeping of commissioned care
“Record keeping relating to the Suffolk County Council commissioned care provided to Mr. PETTIT was found to be inadequate, with significant gaps in records relating to frequency of attendances and details of actions taken during any attendance”
2. inadequate medication management support
“evidence heard during the Inquest raised concerns as to the adequacy of the support provided to Mr. PETTIT in the management of his medication”
3. inadequate catheter management support
“catheter management for Mr. PETTIT was poor, with periods of days, possibly longer, where there was an absence of catheter support provided”