A three week-long inquest into a cluster of deaths at Nottingham’s Queen’s Medical Centre, part of Nottingham University Hospitals NHS Trust, has ended with the coroner asking the Trust to provide an action plan detailing the measures it intends to implement so as to avoid further deaths in similar circumstances in the future. Assistant coroner Laurinda Bower, delivering a narrative verdict at the conclusion of the inquest at Nottingham coroner’s court on 17 December 2021, said that the deaths of patients Anita Burkey (85), William Doleman (76), Carol Cole (53), and Peter Sellars (72) all raised questions about practices and procedures at the Trust, with particular reference to consenting processes and the systems in place for supervision of trainee doctors.

All four patients died within a six month window in 2020 having undergone a procedure called ERCP (endoscopic retrograde cholangiopancreatography) at the hands of the same clinician, gastroenterologist Dr Muthuram Rajaram, although the coroner stressed in her verdict that Dr Rajaram’s competence was not in issue. ERCP is a complex endoscopic technique used to diagnose and treat gallstones. The coroner found that in all the circumstances Mrs Burkey and Mr Doleman should not have had ERCPs in the first instance, and that there were likewise problems with the consenting processes surrounding Mr Sellars’ and Mrs Cole’s procedures.

Phillip McGough of Freeths Solicitors- who, along with his colleague Katy Barnett and counsel Alexandra Pountney of the Ropewalk Chambers in Nottingham, represents the Burkey, Doleman, and Sellars families- commented after the verdict that his clients were both pleased and saddened by the outcome, “Pleased because they have been vindicated in their belief that many things went wrong here and that there were many questions that needed to be answered, but saddened because so much of what happened was avoidable.”

The Trust meanwhile will have 56 days by law to respond to the coroner’s demand for an action plan. Trust deputy medical director John Walsh said: “Although each case is unique, we should have done more to involve families in decisions about patient care as well as taken other actions to manage these complex, high-risk cases. We have made significant changes to a number of our trust policies and processes in these areas, including a review of when and how we declare a Serious Incident, to ensure that patients undergoing an ERCP procedure receive the appropriate and timely care they need."

Freeths Solicitors - How we can help

As clinical negligence lawyers we represent people who have suffered avoidable harm due to failures of medical care and delayed or inappropriate treatment. We know how difficult life can be for those who have suffered and for their families. We are able to assist by ensuring they have access to the services they require, have the funds to pay for private care, and are compensated for the harm.

Freeths Clinical Negligence Solicitors have a national reputation for providing first class advice on all medical claims. If you are concerned about the medical care you or a loved one has received please contact:

Phillip McGough, Clinical Negligence Legal Executive, on 0845 050 3290 or 0115 936 9369 or phillip.mcgough@freeths.co.uk


Jane Williams, Partner, on 0845 272 5724 or jane.williams@freeths.co.uk

Alternatively, please contact:

Adrian Denton: 0115 985 3335 / adrian.denton@freeths.co.uk

Gemma Bedford: 0115 935 0367 / gemma.bedford@freeths.co.uk

Katy Barnett: 0845 271 6752 / katy.barnett@freeths.co.uk

For further information please also visit our website at: http://www.freeths.co.uk/legal-services/individuals/clinical-negligence/