THE death of a man who was a patient in hospital, after suffering an attack involving a metal bar, was contributed to by neglect.
A coroner in Warrington has reached a conclusion into the death of Matthew Charnock, who died in March 2016 following a savage attack.
The 35-year-old was smashed over the head with a wheel brace on Brinton Close in Widnes by Fiddler’s Ferry power station supervisor Steven Cotterill.
The then-39-year-old was jailed for seven years in October 2016 after being found guilty of manslaughter.
Eight years later, an inquest was concluded into Matthew’s death this month, September 2024, at Warrington Coroner’s Court.
Here, the medical cause of death of the accountant, who was born in Trafford and lived in Manchester, was given as blunt force head injury complicated by intracranial sepsis.
As to how, when, where and in what circumstances he died, the court ruled that on March 13, 2016, at around 10.40pm, Matthew was assaulted by being struck over the head with a metal bar.
He was transported by ambulance to Whiston Hospital at 11.44pm with confusion, accompanied by the police.
Both the paramedic and police officer handed over the history of the injury and expressed concerns about his confusion to the hospital receptionist and triage nurse.
Matthew was quickly triaged by the nurse and then referred to an emergency nurse practitioner for review.
The court ruled that record keeping and observations were ‘inadequate’, such that the nurse wrongly recorded him as being alert and also slightly confused.
The emergency nurse practitioner did not review the paramedic patient record form, nor did they take into account the previous history.
It was further said that they did not refer Matthew to a doctor, nor did they request a CT scan in accordance with trust policy before discharging him, having glued his head wound.
On March 15, Matthew was found unresponsive and an ambulance transported him to Salford Hospital, where a CT scan revealed a significant skull fracture and infection.
He was taken directly to theatre, but his condition was unsurvivable, and he therefore sadly passed away at 2.20am on March 16, 2016.
Jacqueline Devonish, senior coroner for Cheshire, reached a narrative conclusion of unlawful killing contributed to by neglect.
The conclusion was welcomed by Matthew’s parents, Matthew Snr and Jean, who said: “We have been fighting for eight years to get recognition and some accountability that Matthew was failed when he was treated at Whiston Hospital.
“For a coroner to find that any death is contributed to by neglect is rare, but this is the correct and best outcome we could have hoped for for Matthew.
“We are particularly grateful to our lawyer Sefton Kwasnik and to PC William Davies, who stayed with Matthew at the hospital in his hour of need.
“Matthew's death has left an empty void in our lives. We know he is not coming back, but coming to terms with this is so hard. We loved him so much.”
Mersey and West Lancashire Teaching Hospitals NHS Trust, which runs Whiston Hospital, has issued a statement.
A spokesman commented: “We would like to express our heartfelt condolences to Matthew's family for their loss, and to once again offer our sincere apologies for the failings in his care at the time.
“Following Matthew's death, a thorough investigation was carried out, the findings of which were shared with Matthew's family.
“Lessons have been learned and robust action taken to ensure a tragic incident like this does not happen again.”
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