Dylan Paul Hill · Prevention of Future Deaths report

On 28 July 2015 an investigation was commenced into the death of Dylan Paul Hill aged 18 years. Following a post-mortem examination, the investigation concluded with an inquest on 19 and 20 December 2017.

The inquest was assisted with evidence from the partner of Dylan Hill who was at the restaurant with him, representatives from Trading Standards and Environmental Heath, the owner of the restaurant and an expert, ████████.

The conclusion of the inquest was that Dylan Paul Hill died at Barnsley General Hospital of an anaphylactic reaction after eating a Korma meal at a restaurant in Barnsley on 17.05.15. Dylan was served a korma containing almond powder. That powder contained almonds and peanuts. The restaurant was not aware the almond powder contained peanuts as it was not labelled and had been decanted into another container. Importantly, no steps had been taken by the restaurant to ascertain the ingredients of the almond powder.

There was no allergen information on the menus or displayed in the restaurant

Dylan didn’t have his EpiPen with him but it cannot be said this would have brought about a different outcome.

Dylan Paul Hill was diagnosed with a peanut allergy at the age of ten. In consequence he had been issued with an adrenaline auto-injector (in this case an EpiPen). Mr Hill also suffered from asthma.

On 17.05.17 Mr Hill and his partner went to a restaurant in Barnsley. Mr Hill ordered a Korma meal and became unwell after eating one or two mouthfuls.

He asked the waiter whether the meal contained nuts and was told it did.

After returning home a short time later Mr Hill collapsed and was confirmed dead on arrival at the local A&E Department.

Pathology examination showed that Mr Hill had died of an anaphylactic reaction.

Examination of the contents of the ingredients of the korma showed that the ‘almond powder’ contained 94% almonds and 6% peanuts. In evidence it was clear the restaurant did not know the ‘almond powder’ contained peanuts as the ingredients had not been checked on purchase, the powder had been decanted into an unlabeled container, and the packaging disposed of.

Evidence was given before the Court of an incident within the same premises in September 2014 where a curry containing nuts was given to a customer who had requested a nut free curry. That customer had an anaphylactic reaction and was taken to hospital where he made a full recovery.

Evidence was also given that the Trading Standards department of the local council had not been told of this incident prior to the death of Mr Hill. Had they known, they would have arranged a priority visit.

After Mr Hill's death the restaurant were issued a prohibition notice that they were not permitted to offer allergen free meals.

Evidence was given that there are no procedures in place for such communications between the health services and Trading Standards in cases of non fatal anaphylactic reactions.

In my opinion there is a risk that future deaths may occur unless cases of non fatal anaphylactic reactions caused by the ingestion of purchases from food business operatives are reported to those regulatory authorities responsible for the supervision and monitoring of food safety and hygiene.

The question therefore arises as to whether the emergency services and health services within the area can work together to ensure that Trading Standards Departments are made aware of all anaphylaxis incidents relating to commercial premises so that the appropriate action can be taken as regards those premises.