Another death, a new inquiry

An investigation has been launched into the death of a man who fell from a trolley in Stafford Hospital's A&E department but was moved to another ward before being properly treated.

The unidentified man was brought into the hospital last month in a drunken state.

He was transferred to the clinical decisions unit despite not being properly assessed in A&E.

Bosses at the trust will now investigate whether this was done to meet the four hour waiting time in A&E, a practice heavily criticised in the Healthcare Commission report back in March.

The patient was never properly examined and he did not have a CT scan. He suffered a cardiac arrest following bleeding in his brain, and – despite being rushed to surgery – he died on the table.

Bosses at the hospital have now launched an investigation into what happened and have referred the death to the Health and Safety Executive who will also be carrying out their own inquiry.

According to a report about the death to the hospital board last month this was the second fall from a trolley in A&E within the last three months.

The board was told that despite the patient being drunk no risk assessment was carried out, there was no evidence in the patient notes of him being referred to surgeons and inappropriate comments were made by nursing staff about the patient which were overheard by a third party.

The board was told action would be taken against staff involved with the man's care.

The board is expected to make a decision on whether to close the CDU next week.

A member of staff from the hospital, who asked not to be named, said the death "proved some staff have learned nothing from the past six months. Dangerous things are still going on at the hospital."

Julie Bailey, from Cure the NHS, said: "This was only reported as a serious untoward incident after the man died. If he hadn't died it would never have been reported.

"How many other serious incidents are not being reported?

"We are so sorry for the poor man and his family. It can't go on like it is and this absolutely shows why we need a full public inquiry."

In a statement Mike Gill, deputy chief executive at Stafford Hospital, said: "The trust has two separate areas that together form the clinical decisions unit. The smaller area was closed following concerns about being able to safely staff and monitor patients. The larger area has had a recent review and both medical and nursing staffing levels have been increased to ensure that safe care is provided to patients.

"There were two serious untoward incidents reported by trust staff during August 2009. These incidents are being thoroughly investigated and the actions described above demonstrate our commitment to eradicate any concerns around patient safety without delay."