Verdict: Coroner finds 'key failings' in care at Stafford Hospital

Bosses at Stafford Hospital have apologised "unreservedly" to the family of John Moore-Robinson, who died within hours of being discharged.

In a statement, the Mid-Staffordshire NHS Trust chief executive, Maggie Oldham, said his death "could and should" have been prevented.

A coroner has identified six key failings and several "shortcomings" in the care of a man who died within hours of being discharged from Stafford Hospital.

John Moore-Robinson, from Leicester, had suffered a ruptured spleen in a mountain biking accident - but doctors failed to spot it.

Sitting at Leicester Coroner's Court, coroner Catherine Mason today said she believed his death was preventable.

A coroner is expected to record her conclusion today in the second inquest into the death of a man from Leicester.

John Moore Robinson died from a ruptured spleen within hours of being discharged from Stafford Hospital.

A report was released shortly after his first inquest, which suggested his treatment could amount to neglect.

A retired consultant has told an inquest that the death of a man who was sent home from Stafford Hospital after a doctor failed to spot a ruptured spleen was "totally preventable".

Dr Ivan Phair was a consultant in A&E at Stafford Hospital in 2006, when John Moore-Robinson was brought in following a mountain bike accident on Cannock Chase.

He was discharged the same day and died at home.

In an earlier report on the death, Mr Phair said that the initial examination of John Moore-Robinson was "brief and incomplete".

Dr Girish Sharma was the Senior House Officer who conducted that examination.

Asked what more Dr Sharma should have done, Mr Phair said, "He should have put his stethoscope on and listened to the quality of the abdomen and the sound of the bowels."

"He hasn't written anything down to suggest that he has listened to whether or not the bowel sounds were absent or present."

A second inquest in the death of a Stafford Hospital patient, who was sent home with an undiagnosed ruptured spleen, will resume later today.

John Moore-Robinson died in 2006 after a doctor failed to spot the ruptured spleen following a mountain bike accident.

Coroner Catherine Mason adjourned the inquest in April and requested that Mid Staffordshire NHS Foundation Trust, who run the hospital, make the necessary staff available as witnesses.

After the first inquest in 2007 an internal report from the hospital said Mr Moore-Robinson's treatment could have been negligent.

Yesterday the inquest heard from a Mid Staffs nurse, who said the trust was understaffed at the time of Mr Moore-Robinson's death.

Today the inquest will hear from Dr Ivan Phair, a consultant in the A&E unit, who wrote the trust's internal report. In his report he said Mr Moore-Robinson should have had an ultrasound examination, which would have identified the damage to his spleen.

A statement was read to the court from Mark Saville, a staff nurse at Mid Staffordshire NHS Trust, that talked of staff shortages at the time Mr Moore-Robinson died.

The statement went on to describe how two nurses in Accident and Emergency would have responsibility for thirteen patients.

The court was also told that "there was no minimum standard" for the taking of vital signs from patients at Mid Staffs at the time.

A second inquest is to resume into the death of Stafford Hospital patient John Moore-Robinson, 20, who died after being sent home from the hospital with an undiagnosed ruptured spleen in April 2006 following a mountain bike accident.

Coroner Catherine Mason adjourned the inquest in April and requested that Mid Staffordshire NHS Foundation Trust, who run the hospital, make the necessary staff available as witnesses.

After the first inquest in 2007 an internal report from the hospital said Mr Moore-Robinson's treatment could have been negligent.

REPORT: Second inquest granted into death of man at Stafford Hospital