Listeria outbreak: Man died after eating sandwich at Royal Derby Hospital, inquest hears

A coroner has apologised to the family of a man who died more than four years ago after contracting listeria at a hospital.

Ian William Hitchcock, 52 and from Belper, died in June 2019 having consumed a pre-packaged chicken sandwich at Royal Derby Hospital - the batch of which was later linked to an outbreak of listeria - an inquest has been told.

Area coroner Peter Nieto told the family it was "wrong" that it had taken four years for the inquest to take place and apologised for the delays.

Speaking at the inquest at Chesterfield coroners' court on Friday, the family said: "We now look forward to closure as a family. We accept your apology for the four-year delay but really the coroner's system should have prevented it taking quite as long as that."

Mr Hitchcock, a businessman who lived with his wife Miranda in Crich, had been diagnosed with lung cancer the month before his death with the inquest hearing there was "no realistic treatment" at the stage he was diagnosed.

He had attended Royal Derby Hospital on the morning of May 7, 2019, where he ate a pre-packaged chicken sandwich and returned home in the evening after being provided with medication.

On May 15, he became unwell at his home address and was taken to hospital via ambulance. 

On May 17, the infection was confirmed as listeria before Mr Hitchcock was subsequently transferred to Nottingham City Hospital. 

The strain of listeria was traced back to a batch of pre-prepared chicken mayo sandwiches produced by the Good Food Chain and supplied to over 40 NHS trusts - including Royal Derby Hospital.

A Home Office pathologist gave Mr Hitchcock’s cause of death as liver failure and listeria.

Evidence was heard from two doctors who differed in their opinions as to whether the businessman died with listeria or from listeria. 

Jurors were told of Mr Hitchcock’s higher susceptibility to diseases that attack the immune system and Dr Frances Hollingbury, pathologist, told the inquest she believed that while his advanced lung cancer was "terminal" it was the listeria that "tipped the balance".

Jurors concluded: "During (Mr Hitchcock's) visits to (Royal Derby Hospital) it is probable that Ian consumed food containing higher levels of listeria."

Hospital offers 'heartfelt condolences'

The jurors heard evidence that, while at Royal Derby Hospital, Mr Hitchcock had eaten a chicken sandwich from Staffordshire-based Good Food Chain - a firm later connected with an outbreak of seven deaths linked to listeria from pre-packaged sandwiches at hospitals across the country.

Inspections at the hospital, carried out after the death of Mr Hitchcock, found that sandwiches were being stored at insufficient temperatures at Royal Derby Hospital, with evidence to suggest this had been the case leading up to the businessman’s death.

Jurors were told of "failings" of record-keeping but a trust representative said they had taken steps to improve this since Mr Hitchcock’s death. 

The representative pointed out that the site had been awarded a five-star food hygiene rating by the local authority just a month before the listeria outbreak was identified.

Public Health England published a report into the listeria outbreak in which they concluded that, between May 14 and June 16, 2019, nine confirmed cases of listeriosis associated with the outbreak were identified in England.

All nine cases had received care at hospitals supplied by the Good Food Chain prior to onset, and the consumption of these pre-packed sandwiches was confirmed for eight cases. 

Of these, six consumed chicken sandwiches and two reported consuming other sandwiches (including cheese and egg).

The chicken in the sandwiches was provided by North Country Cooked Meats which also tested positive for an outbreak of listeria. 

Both companies have now dissolved.

A University Hospitals of Derby and Burton NHS Foundation Trust spokesperson said: "Our heartfelt condolences remain both with Ian's family and those others across the country who were sadly impacted by the national listeriosis outbreak in 2019.

"While the inquest acknowledged that it was not possible to determine exactly when Ian consumed listeria bacteria, at the time of the national outbreak in 2019 we took immediate steps to improve aspects of how food was stored at the Royal Derby Hospital and have put significant changes in place since that time, including twice-daily food fridge temperature checks, creating a dedicated team to monitor and deliver food, introducing temperature-controlled vending machines, and putting improved processes in place to better trace what food is given each patient.

"We provide food to thousands of patients every day and we take safety standards very seriously, with Royal Derby Hospital holding a top food hygiene rating."