Concerns raised 4 Miscalculation of clot risk when assessing eligibility for the combined contraceptive pill View source Failure to calculate cardiovascular risk when assessing eligibility for the combined contraceptive pill View source Failure to record significantly elevated blood pressure readings in the medical record View source Failure to bring significantly elevated blood pressure readings to the responsible clinician’s attention View source See 1 more concern
Actions described in response An action is something this recipient says it has done, is doing, or plans to do in response to the concern raised. 3
Action
Maintain staff vigilance to ensure patients using the machine submit their readings before leaving.
View source
Action
Relocate the blood-pressure machine to the opposite reception-area wall to improve staff oversight while preserving confidentiality.
View source
Action
Place a sign above the blood-pressure machine directing patients to give their readings to reception.
View source
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AI-generated summary
Lauren Louise MURDOCK · 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
Lauren Murdock died from a myocardial infarction at age 27. Concerns included a significantly elevated blood pressure reading that was not recorded in her medical record or brought to the GP’s attention, and errors in assessing clot and cardiovascular risks when prescribing the combined contraceptive pill. She died ten days after the elevated blood pressure reading was taken.
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 Lathom Road Medical Centre; that does not assign responsibility.
PFD Monitor interpretation Miscalculation of clot risk when assessing eligibility for the combined contraceptive pill
Wider context from the report “The general practitioner (GP) who prescribed Ms Murdock the combined contraceptive pill consulted the UK medical eligibility criteria (MEC) guidelines before she did so.
However, she then miscalculated Ms Murdock’s clot risk and she failed to calculate her cardiovascular risk.
She miscalculated the clot risk because she did not appreciate the difference between a family member with history of clot over the age of 45 years, and one under the age of 45 years . If she had calculated correctly, she would have recognised that Ms Murdock was at higher risk and she would have taken a different course of action.
She failed to calculate the cardiovascular risk because did not notice the relevant box in the MEC guidelines 11 page summary. If she had noticed the box, she would have recognised that Ms Murdock had multiple cardiovascular risk factors (obesity and smoking) and should only be prescribed Dianette following specialist consultation, if at all.
” Open source report × 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 Lathom Road Medical Centre; that does not assign responsibility.
PFD Monitor interpretation Failure to calculate cardiovascular risk when assessing eligibility for the combined contraceptive pill
Wider context from the report “The general practitioner (GP) who prescribed Ms Murdock the combined contraceptive pill consulted the UK medical eligibility criteria (MEC) guidelines before she did so.
However, she then miscalculated Ms Murdock’s clot risk and she failed to calculate her cardiovascular risk .
She miscalculated the clot risk because she did not appreciate the difference between a family member with history of clot over the age of 45 years, and one under the age of 45 years. If she had calculated correctly, she would have recognised that Ms Murdock was at higher risk and she would have taken a different course of action.
She failed to calculate the cardiovascular risk because did not notice the relevant box in the MEC guidelines 11 page summary . If she had noticed the box, she would have recognised that Ms Murdock had multiple cardiovascular risk factors (obesity and smoking) and should only be prescribed Dianette following specialist consultation, if at all.
” Open source report × 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 Lathom Road Medical Centre; that does not assign responsibility.
PFD Monitor interpretation Failure to record significantly elevated blood pressure readings in the medical record
Wider context from the report “At inquest, I heard that Lauren visited the practice on 13 October 2021 and saw a healthcare assistant. Her blood pressure was taken and was found to be significantly elevated at 166/90, with a heart rate of 98.
That blood pressure reading does not appear to have found its way to Ms Murdock’s medical record , and it was certainly not brought to Dr ████████ attention.
” Open source report × 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 Lathom Road Medical Centre; that does not assign responsibility.
PFD Monitor interpretation Failure to bring significantly elevated blood pressure readings to the responsible clinician’s attention
Wider context from the report “At inquest, I heard that Lauren visited the practice on 13 October 2021 and saw a healthcare assistant. Her blood pressure was taken and was found to be significantly elevated at 166/90, with a heart rate of 98.
That blood pressure reading does not appear to have found its way to Ms Murdock’s medical record, and it was certainly not brought to Dr ████████ attention .
” Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Maintain staff vigilance to ensure patients using the machine submit their readings before leaving.
Verbatim wording from the response “Staff to remain vigilant of any patients using the machine to ensure patients do not leave without submitting a reading.” Source location Response from Lathom Road Medical Centre_Event Analysis
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Relocate the blood-pressure machine to the opposite reception-area wall to improve staff oversight while preserving confidentiality.
Verbatim wording from the response “1. Re-site the machine closer to the reception desk so staff can keep a closer eye on the patients using the machine, the only problem with this is that it can’t be placed right next to the reception desk as it would raise confidentiality issues with the patients already queuing at the front desk. Reception staff suggested to place the machine on the opposite wall of the reception area where they would have better oversight of the patient – we shall try this.” Source location Response from Lathom Road Medical Centre_Event Analysis
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Place a sign above the blood-pressure machine directing patients to give their readings to reception.
Verbatim wording from the response “A sign has been placed above the blood pressure machine guiding patients to hand the reading to the receptionist once checked.” Source location Response from Lathom Road Medical Centre_Event Analysis
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continuous staff supervision of every patient using the blood pressure machine is not always possible because reception staff are already occupied with front-desk duties.
Verbatim wording from the response “5. Dr ████████ suggested having a dedicated member of staff to supervise each patient checking their blood pressure throughout the process. ████████ mentioned that this is not always going to be possible as staff are already busy at the front desk and wouldn’t always have time to supervise every patient. We agreed that if staff members are free then they should try to stay with the patient though the monitoring process, failing that they should give the patient clear instructions to submit their readings to the front desk.” Source location Response from Lathom Road Medical Centre_Event Analysis
Open published response
Includes reports addressed to a minister or senior office-holder acting for this organisation.
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Information checked against published PFD reports and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations