Ed Ramsay represented the family at the inquest into the death of Herbert Chandler (deceased).
Mr Chandler died as a result of acute respiratory failure following an erroneous aspiration to the wrong side of the chest. After two days of evidence and submissions HM Coroner concluded that a series of failings and systemic errors at East Kent Hospitals University NHS Foundation Trust had caused or contributed to the death; and, accordingly, that Article 2 of the European Convention on Human Rights applied to her investigation.
HM Coroner has ruled that a Prevention of Future Death Report (previously Rule 43) is to be made pursuant to paragraph 7(1) of Schedule 5 to the Coroners and Justice Act 2009 and Regulation 28 of The Coroners (Investigations) Regulations 2013.
The conclusions and findings of the inquest were reported in the local and national press, details of which are available here.