Nursing home staff waited two days to inform a hospital that a dying patient had been given an insulin overdose because they were “following procedures”, an inquest heard.

Irene Martin, aged 84, died a month after she was given a massive insulin overdose at Himley Mill Nursing Home, near Dudley. Black Country coroner Robin Balmain said he was incredulous about the delay in passing on the information and he could only assume the managers had “panicked and acted like rabbits in a headlamp”.

He said: “In the cold light of day it seems astonishing that adult protection procedures take precedence over someone’s life.

“I can’t understand how a responsible nurse can think that some bureaucratic protocol can prevent them from telling the hospital what they know.”

However the coroner said he was satisfied the nursing home had already taken prompt action to correct the error when Mrs Martin, who moved to the home from Old Canal Walk, Tipton, was taken to hospital and the delay in informing doctors of the overdose did not contribute to her death.

The cause of Mrs Martin’s death was given as bronchial pneumonia, due to hypoglycaemic coma, resulting from an insulin overdose.

Mr Balmain said both nurses had made a genuine mistake and recorded a verdict of accidental death.

Bupa regional manager Lorraine McGarry-Wall and former Himley Mill nursing home manager Gillian Howarth discovered the error made by nurse Tracy Bowen on November 5 but did not report their findings to Russells Hall Hospital until November 7.

Mrs McGarry-Wall blamed local authority procedures to protect vulnerable adults for the failure.

Bupa spokesman Gill Carson said Tracy Bowen was dismissed in 2006 following the incident. The nurse, from Bilston, was given a caution in September by the Nursing and Midwifery Council.

 The spokesman added Gillian Howarth, who left Himley Mill in June, had now moved to another care home.