Coroner's Report: Gross Care Failure Contributed to Death
An inquest found that a 'gross' medical failure at a GP surgery played a role in the death of a 53-year-old man, Dr. Mark Ryan Foster.
Dr. Foster, a university researcher, died at home on February 17, 2024, due to a pulmonary embolism. He had been experiencing shortness of breath since December 2023 and consulted his GP on January 11, 2024.
The coroner's report raised concerns about the governance of Dr. Foster's GP practice, Castlegate and Derwent Surgery.
A chest x-ray was carried out, which was 'unremarkable', but Dr. Foster's symptoms continued, prompting him to return to his GP. The senior coroner for Cumbria, Kirsty Gomersal, published a Prevention of Future Deaths Report on October 20, 2025, following the inquest.
Author's summary: Gross medical failure contributed to the death of a 53-year-old man.
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