Robert Watt
17 Apr 2015 · Coroner Patricia Harding · Mid Kent & Medway
The coroner's concerns
1. lack of explanation of haematuria clinic attendance
“No party explained the importance of attendance at the haematuria clinic to Mr. [name redacted] or his wife”
2. letter not sent to patient nor placed on records
“The letter communicating the cancellation of the clinic was not sent to the deceased, nor was it placed on the medical records”
3. missing referral and management documentation
“There is no documentation relating to the referral to urology and forward management of the haematuria within the medical records”
4. advice sought via most junior doctor
“On each occasion that the medical team consulted with renal or urological physicians in seeking advice how to manage their patient, the consultation was conducted through the most junior doctor on the ward (FY1)”
5. urologist not consulted despite suspected malignancy
“A urologist was not asked to review Mr. [name redacted] in circumstances where a malignancy was suspected and he was suffering from weight loss and haematuria both of which are recognised symptoms associated with bladder cancer”
6. patient discharged despite pending OGD
“The evidence has shown (although it does not relate to the death) that Mr. [name redacted] was discharged from the hospital even though he was scheduled to have an OGD at the hospital on the date of discharge, which it appears that the physicians were unaware of”
Responses
No published response was found on judiciary.uk.