Recipient

British Obesity and Metabolic Surgery Society

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First report 27 Apr 2016•Latest report 27 Apr 2016

Recipient record

Reports, concerns and published responses

Private and voluntary organisations · Health professional body. This page brings together reports naming this recipient and response statements clearly connected to concerns raised in those reports.

Reports
1

Naming this recipient

Published responses
0%

Found for named reports

Concerns addressed
0

Across all linked responses

Stated actions
0

Described in responses

Reports over time

Reports over time

Reports naming this recipient by issue year.

Evidence profile

Report topics

Share of this recipient’s reports compared with all other recipients.

0%published responses found
0stated actions described

Topic comparisons are not available in the current evidence snapshot.

Concerns and recipient responses

Statements from British Obesity and Metabolic Surgery Society linked to the concerns in each report. Select any concern, action or position to view the source wording.

  1. London Greater Inner South

    AI-generated summary

    KATHRYN BULL · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Kathryn Bull underwent gastric bypass surgery in January 2014 and subsequently experienced difficulty tolerating food, dizziness, lethargy, vomiting and blackouts. She was admitted to hospital after a fall, deteriorated with hyperammonaemia syndrome and multi-organ failure, and died following a cardiac arrest on 4 December 2014. The principal concern was that hyperammonaemia syndrome is an extremely rare adverse consequence of gastric bypass surgery, with symptoms that were not well understood and did not initially trigger concerns during follow-up.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to British Obesity and Metabolic Surgery Society; that does not assign responsibility.

    PFD Monitor interpretation

    Lack of understanding of hyperammonaemia syndrome symptoms following gastric bypass surgery

    Wider context from the report

    “(2) The pathologists, ████████ (the gastric bypass consultant who performed the surgery on Mrs Bull) and ████████ (the consultant intensivist who treated her in hospital) confirmed that hyperammonaemia syndrome has been identified as an adverse consequence of gastric bypass surgery. (3) However this is extremely rare: there appear to have been only 25 or so reported cases worldwide¹. Very little appears to be known about the condition and so the symptoms are not well understood. ”
    Open source report
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Published response patterns

Compared with other recipients in reports included in PFD Monitor

Describes published response evidence, not performance.

Published responses found

0%
0%All other recipients 58%
0%100%

How actions were described at the time

This respondent
All other recipients
47%25%27%<1%<1%
  • Completed
  • In progress
  • Planned
  • Unclear
  • Partially completed

Statuses reflect what recipients said at the time. PFD Monitor does not verify whether actions happened.

Types of action described in responses

Percentages use all actions described by each group. An action may have more than one type, so percentages do not total 100%.

Information checked against published PFD reports and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026