Asher Blackman
PFD Report
Response Pending
Ref: 2026-0133
38 days left · 0 of 1 responded
Response Status
Responses
0 of 1
56-Day Deadline
1 May 2026
38 days left to respond
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Coroner’s Concerns
That the initial assessment for Mr Blackman by the District Nurses did not record his next of kin details or what to do should the district nurse not be able to gain access. The policy following no access did not take into account the need for police involvement where the life of the patient may be at risk through non access.
Report Sections
Investigation and Inquest
On the 29 September 2025 I commenced an investigation into the death of, Asher Blackman, aged 72. The investigation concluded at the end of the inquest on17 December 2025. The conclusion of the inquest was consequences of diabetes.
Circumstances of the Death
On the 21st September 2025, Asher Blackman died in hospital having collapsed at his home, where he was found to be profoundly hypoglycaemic. It is unclear why he became so hypoglycemic as no District Nurse visited the evening before to provide his insulin injection. It is likely than an imbalance between his food and insulin caused the hypoglycaemia. Had the District Nurse been able to get access to Mr Blackman, a blood sugar reading would have been taken and an opportunity to treat Mr Blackman was therefore missed.
Similar PFD Reports
Reports sharing organisations, categories, or themes with this PFD
Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.