Tamara Mills
29 Oct 2015 · Coroner Terence Carney · Gateshead & South Tyneside
A similar concern from this report was raised again 2 times later. See the linked reports.
The coroner's concerns
1. lack of long term management of asthma
“The care management and treatment of this child on the innumerable occasions she presented with an exacerbation of asthma, was centred solely on treating the immediate presentation as an isolated acute event seeking its stabilisation and returning her to the care of her family.”
2. lack of coordinated record keeping
“No co-ordinating record of these occasions”
3. lack of event frequency analysis
“No analysis of the frequency or circumstances of the events”
4. lack of medication level analysis
“No analysis of the medication or level of medication prescribed”
5. lack of effectiveness determination
“No determination of its effectiveness the frequency or regularity of its use”
6. lack of deterioration appreciation
“No appreciation of the deteriorating nature of her respiratory condition”
Linked reports
Identical hazardConfidence 0.92 · high
This report
“The care management and treatment of this child on the innumerable occasions she presented with an exacerbation of asthma, was centred solely on treating the immediate presentation as an isolated acute event”
Later report
“The care management and treatment of this child during his final year of life with an exacerbations of asthma was centred solely on treating the immediate presentation as an isolated acute event”
Identical hazardConfidence 0.92 · high
This report
“The care management and treatment of this child on the innumerable occasions she presented with an exacerbation of asthma, was centred solely on treating the immediate presentation as an isolated acute event seeking its stabilisation and returning her to the care of her family.”
Later report
“The medical management of this child's asthma attacks on the innumerable occasions she presented to her general practice and hospital was centred solely on treating the immediate presentation as an isolated acute event seeking its stabilisation and returning her to the care of her family”
Responses
No published response was found on judiciary.uk.