John Ramsden · Prevention of Future Deaths report

On the 3rd February 2017 I commenced an investigation into the death of John Ramsden, 82 years, born 23rd August 1934. The investigation concluded at the end of the Inquest on 5th July 2017.

The medical cause of death was:-

Ia Bronchopneumonia
II Dementia (terminal)

The conclusion of the Inquest was John Ramsden died of Natural Causes.

John Ramsden who suffered from dementia was subject to a Deprivation of Liberty Safeguarding Authorisation at Lever Edge Care Home where he resided. On the 8th January 2017 he was seen by a Doctor and medication for a suspected Urinary Tract Infection was prescribed. The pharmacy did not deliver that medication until 9th January 2017 and it was not therefore administered until that date. Whilst John Ramsden was a patient at Lever Edge Care Home his eldest daughter was consulted about his care but his other two daughters were not so consulted.

1. During the Inquest evidence was heard that:-

i. The evidence at the Inquest was that John Ramsden’s eldest daughter was consulted about decisions to his care. However, John Ramsden’s other two daughters were not consulted, particularly about his end of life care and about whether he should be admitted to hospital for treatment or not.