A coroner has found failures in care led to the death of a loving father at Royal Blackburn Hospital.

Chris Brandon, 40, died on July 31, 2023, having arrived at hospital more than a week before with pain in his throat.

Chris, from Burnley, was a father to three as well as a step-father, and a large family presence for his inquest at Preston Coroner’s Court showed how loved he was.

Coroner Kate Bisset said Chris ultimately died as a result of brain damage suffered when he was starved of oxygen during a cardiac arrest, which was caused by an acute airway obstruction started by a pharyngeal abscess (a collection of pus deep in the back of the throat).

Ms Bisset said staff who were looking after Chris were not suitably experienced in the needs he had at that time, and he should have instead been under the care of specialists.

Lancashire Telegraph: Chris Brandon with his childrenChris Brandon with his children (Image: Family)

Had he been, it is more likely than not he would not have died at the time he did.

An investigation led by Carmel Hindle, patient safety investigator for East Lancashire Hospitals NHS Trust, found 26 points of concern.

Ms Hindle, in her evidence, said concerns were identified around Chris’ care only after he had died because an incident report was not submitted until then.

The findings of Ms Hindle’s report were endorsed and the hospital said it was doing its best to put everything in place to make sure nothing like this happens again.

One point mentioned was Chris’ scenario being used as part of a training exercise, which the family agreed to.

Chris, who was born in Shoreham-by-Sea, West Sussex, and worked as a fraud prevention officer, first went to Royal Blackburn with a sore throat after a previous course of antibiotics had not worked.

A physical examination showed swelling around his tonsils which was deemed to either be an abscess or erythema.

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Doctors made three attempts to drain the swelling but these were unsuccessful.

Concerns were raised about Chris’ breathing and when his pulse was checked by one of the doctors the emergency buzzer was pulled as they could not find one.

His heart was restarted on that occasion but his breathing issues continued.

On July 26, a brain scan showed significant brain damage as a result of the cardiac arrest.

He continually had seizures and was given four different anti-seizure medications, but these proved futile due to the extent of the brain damage.

Ms Bisset did not order a report into the trust or the hospital as she felt changes were being made following what happened.

Lancashire Telegraph: Royal Blackburn HospitalRoyal Blackburn Hospital (Image: Newsquest)

She offered a narrative conclusion, saying: “Christopher Brandon died on July 31, 2023, at Royal Blackburn Hospital as a result of brain damage caused by a cardiac arrest, which resulted from an airway blocked by an abscess.

“He had suffered from tonsillitis for three days. Following his admission, this was not detected by staff.

“He was starved of oxygen which caused his heart to stop.

“This would have been avoided if the care was overseen by appropriate specialists.

“The team tried their best in the circumstances but it should not have got to that point.”

Ms Bisset added: “He leaves behind a legacy. He donated his organs which saved the lives of other people.

“His tragic death means changes will be made.”