A coroner has found a Mersey Community Hospital patient's death was preventable.
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Margaret Patricia Kenney died at the hospital from upper gastrointestinal bleeding three days before her 84th birthday in November 2017.
Coroner Rod Chandler said Mrs Kenney had a daily prescription for the medication pantoprazole, which treated her gastro oesophageal disease.
Mr Chandler said records showed Mrs Kenney had requested the medication during her last admission to the MCH, but it was not recorded as having been provided.
"Mrs Kenney was not administered pantoprazole or an alternative... for the duration of her last admission," Mr Chandler said.
"Whether this was by oversight or was intentional is not apparent."
Mr Chandler said a medical doctor advised him Mrs Kenney's haemorrhage, and therefore death, would have been avoided if pantoprazole had been maintained.
Mr Chandler said Acting Director of the Tasmanian Health Service, Dr Helen McCardle, conducted an internal review following Mrs Kenney's death and made a number of recommendations.
Mrs Kenneys death would have been prevented if she had continued to receive her regular dosage of pantoprazole.
- Coroner Rod Chandler
"The recommendations made will, if followed, reduce the risk of a similar preventable death occurring in the future," he said.
A THS spokesman said Dr McCardle's recommendation's have been implemented "where appropriate".
"Patients with complex multiple co-morbidities present particular treatment challenges despite the very best efforts of medical professionals.
"We are always striving to ensure the level of care provided is the very best it can be, which is why cases such as these are fully examined."
Mr Chandler made no further recommendations.
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