Source · Prevention of Future Deaths
Ester Wood
Ref: 2018-0176
Date: 6 Jun 2018
Coroner: David Pojur
Area: North Wales (East and Central)
Responses identified: 0 / 4
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Ongoing, systemic problems with ambulance delays, emergency department access, and patient flow continue to place lives at risk, despite repeated prior warnings.
Date
6 Jun 2018
56-day deadline
2 Sep 2018 est.
Responses identified
0 of 4
Coroner's concerns
Ongoing, systemic problems with ambulance delays, emergency department access, and patient flow continue to place lives at risk, despite repeated prior warnings.
View full coroner's concerns
_ The issues of ambulance delaysladmission to EDlavailability of resourceslpatient flow and the multifactorial problems associated with cases of this nature have been reported upon by this Court on several occasions following previous inquests, most recently on 17th May 2017 by Mr Gittins_ Senior Coroner concerning the death of Lilly Baxendall. Despite the above reports issued to the Health Board and other relevant bodies these problems continue to the present and patients' lives are placed at risk as a result Coroner'$ Office, County Hall, Wynnstay Road Ruthin, LLIS IYN Tel 01824 708047 Fax 01824 708048 being The day being
Report sections
Investigation and inquest
On the 18th April 2017 this Court commenced an investigation into the death of Ester Jane Wood (DOB.8.70 DOD 6.4.17) The investigation concluded at the end of the inquest on the 6th June 2018 The conclusion of the inquest was one of Natural Causes the Cause of Death recorded as 1(a) Bronchopneumonia, Left Ventricular and Liver Failure (b) Myocardial Infarction Alcoholic Liver Disease (c) Recurrent Pancreatic Neuroendocrine Tumour
Circumstances of the death
Ester Wood was taken from her home address to the Maelor Hospital via ambulance on 03.04.07 and waited from 20.O5hrs until Iam in the ambulance where she was stable. On admission and subsequent examination she was in a very poor clinical condition. Despite best efforts several organs were failing and she did not respond to medical interventions_ position was futile.
Action should be taken
In my opinion action should be taken to prevent future deaths and believe you have the power to take such action:
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Report details
- Reference
- 2018-0176
- Date of report
- 6 June 2018
- Coroner
- David Pojur
- Coroner area
- North Wales (East and Central)
Responses identified
Responses identified
0 of 4
4 responses not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 2 Sep 2018 (estimated).
Sent to
- BCUHB
- HM Stanley Site
- Welsh Ambulance Services NHS Trust
- Ysbyty Gwynedd