Moira Farnell: Prevention of Future Deaths Report
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Date of report: 28/08/2024
Ref: 2024-0472
Deceased name: Moira Farnell
Coroners name: Tom Osborne
Coroners Area: Milton Keynes
Category: Other related deaths
This report is being sent to: Milton Keynes City Council
| REGULATION 28 REPORT TO PREVENT DEATHS | ||
|---|---|---|
| THIS REPORT IS BEING SENT TO: [REDACTED], Chief Executive of Milton Keynes City Council | ||
| 1 | CORONER I am Tom OSBORNE, Senior Coroner for the coroner area of Milton Keynes | |
| 2 | CORONER’S LEGAL POWERS I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. | |
| 3 | INVESTIGATION and INQUEST On 09 May 2024 I commenced an investigation into the death of Moira FARNELL aged 79. The investigation concluded at the end of the inquest on 17 July 2024. The conclusion of the inquest was that: Accident | |
| 4 | CIRCUMSTANCES OF THE DEATH The deceased fell on the pavement outside her house, [REDACTED], Bletchley, Milton Keynes on the 18th April 2024. She hit her head on the pavement. She was taken to Milton Keynes University hospital and following a CT scan was diagnosed with a traumatic subdural haematoma. Her condition deteriorated and she died on 6th May 2024 at Milton Keynes University Hospital. | |
| 5 | CORONER’S CONCERNS During the course of the investigation my inquiries revealed matters giving rise to concern. In my opinion there is a risk that future deaths could occur unless action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows: (brief summary of matters of concern) The deceased’s family contacted the council prior to her death concerning the hazard posed by the broken pavement, but no action was taken to repair the pavement. | |
| 6 | ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe you (and/or your organisation) have the power to take such action. | |
| 7 | YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report, namely by October 10, 2024. I, the coroner, may extend the period. Your response must contain details of action taken or proposed to be taken, setting out the timetable for action. Otherwise you must explain why no action is proposed. | |
| 8 | COPIES and PUBLICATION I have sent a copy of my report to the Chief Coroner and to the following Interested Persons [REDACTED]. I am also under a duty to send a copy of your response to the Chief Coroner and all interested persons who in my opinion should receive it. I may also send a copy of your response to any person who I believe may find it useful or of interest. The Chief Coroner may publish either or both in a complete or redacted or summary form. He may send a copy of this report to any person who he believes may find it useful or of interest. You may make representations to me, the coroner, at the time of your response about the release or the publication of your response by the Chief Coroner. | |
| 9 | Dated: 28/08/2024 Tom OSBORNE Senior Coroner for Milton Keynes | |