Amanda Harris

PFD Report Historic (No Identified Response) Ref: 2015-0216
Date of Report 10 June 2015
Coroner Andrew Walker
Coroner Area London (North)
Response Deadline est. 5 August 2015
Hospital Death (Clinical Procedures and medical management) related deaths
Judiciary.uk Report PDF
Coroner's Concerns (AI summary)
Mrs Harris was discharged from the Minor Injuries Unit without a doctor's review, consideration of anticoagulant therapy, or assessment of potential immobility effects from her injury.
View full coroner's concerns
_ _ That Mrs Harris was not seen by a doctor before leaving the Minor Injuries Unit; that anticoagulant therapy was not considered and that when an appointment for the fracture clinic the potential immobility from the injury and effects of that immobility were not assessed_ the being get having fixing the

Her Majesty's Coroner for the Northern District of Greater London (Harrow; Brent; Barnet; Haringey and Enfield)
Sent To
  • Mount Vernon Hospital
Response Status
Linked responses 0 of 1
56-Day Deadline 5 Aug 2015
About PFD responses

Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.

Source: Courts and Tribunals Judiciary

Report Sections
Investigation and Inquest
On the 13th November 2014 opened an inquest touching the death of Amanda Susan Harris aged 62 years old. The inquest concluded on the 26"h May 2015. The conclusion of the inquest was Narrative" the medical case of death was Ia Massive Pulmonary Thromboembolism 1b Immobility following fracture of the right metatarsal bone. And under paragraph 2 Obesity CIRCUMSTANCES @F THE DEATH On the 18h October 2014 Amanda Susan Harris fell at her care home and fractured a bone in her right foot: Mrs Harris was taken to the minor injuries unit where a cast was placed on her foot and an appointment made to a fracture clinic, there no such facility at the Minor Injuries Unit Mrs Harris returned to her care home where she was unable to out of bed; On the 1st November 2014 she was found died in her bed by care home staff:
Action Should Be Taken
In my opinion action should be taken to prevent future deaths and believe you [ANDIOR your organisation] have the power to take such action:
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Related Inquiry Recommendations

Public inquiry recommendations addressing similar themes

Service change continuity plans
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Continuing responsibility for care
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Follow up of patients
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Prevent discharge of hospitalised children with concerns until home is safe
Laming Inquiry
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Require consultant or paediatrician permission for discharging children with protection concerns.
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Care and discharge planning
Require documented future care plan for discharging children with protection concerns.
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Care and discharge planning
Ensure identified GP for children with deliberate harm concerns discharged from hospital.
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Establish comprehensive counselling and support services as integral to patient care
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Require every trust to provide a professional bereavement service and online information
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.