Before HM Assistant Coroner for South Yorkshire (East District) - Mrs S L Slater - Doncaster Coroner's Court

Conclusion 5 July 2018

Gail Pickles, the daughter of Richard Lee says as follows;

I am extremely relieved that the inquest process is finally over and that the Coroner made findings that my father received two sets of his prescribed medication, on two consecutive days, by two different Boots Pharmacies and that this was in error. In addition, that error then had fatal consequences as although the primary cause of my father’s death was heart disease, the high levels of Dosulepin and the double dosage of his other medications, had a cumulative effect increasing the risk of cardiac death and was therefore a contributory factor to my father’s death.

I had watched the BBC Inside Out programme on Boots earlier in the year, and I feel as if I have been treated as badly by Boots; in very much the same way as the other bereaved families. In that programme Boots were reported as saying there had been no further deaths since 2013 associated with dispensing errors. I was shocked and appalled that this statement was made when it was well within their knowledge, since the end of December 2016, that duplicate medication packs had been sent to my father, that there was evidence that he had taken both sets and that this error might therefore have been a causative factor in my father’s death.

In a day and age where it is expected that large commercial chains should have in mind their corporate responsibility, I was disappointed and upset that Boots appeared to be uncooperative during this whole process, a point that was recorded in open court by the Coroner during the Inquest Hearing. 

During the police and inquest investigation, I have seen evidence of a number of errors in the way in which Boots dealt with my father’s medication. I accept that these did not specifically relate to his death, but I do have concerns about whether those errors could affect other users of Boots pharmacies. Therefore, I will be raising them elsewhere.  I also do not understand how, when there has been a fatal incident such as this, that an internal report could be submitted stating that “no harm was caused, that he did not receive medical attention and that it did not need escalating to a higher level”. 

Still, to this day, no one from Boots has every apologised to me for the error or my father’s death and I am devastated to see that no one from Boots attended today when the Coroner handed down her findings and conclusions.  I have repeatedly, over the past 18 months, written to Boots asking for them to review how they treat families of patients who have been harmed or, like in my case, where there has been a death – I have yet to receive a positive response from them. 

The family are being represented by Gemma Vine, Minton Morrill Solicitors, Leeds and Counsel Andrew Bridgman from St Johns Buildings Chambers, Manchester