Registrar writes to Gateshead and South Tyneside Coroner following concerns
The GCC has replied to the Regulation 28 (Prevent Future Deaths) report received in January 2025 following the inquest into the death of Joanna Kowalczyk.
17.03.25
In January 2025, the GCC received a Regulation 28 (Prevent Future Deaths) report from the Gateshead and South Tyneside coroner. This followed an inquest into the tragic death of 29-year-old Joanna Kowalczyk on 16 October 2021.
In her report, the Coroner asked the GCC to consider the following concern.
(I am) “concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.”
Nick Jones, GCC Chief Executive and Registrar, has now written to the coroner to set out how her concerns will be considered and the expected timing of that work.
In order to give full and careful consideration to her concerns the GCC has convened an expert group (with representatives from across the profession and beyond) to review the technical and clinical nature of the issues identified by the coroner: Read the Terms of Reference of the Review.
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