Coroner urges Government and HSE to act after inquest findings
22nd August 2011
On the morning on 14th November 2007, Maria Ighodalo was found
dead at her home in Upper Norwood, London. At the inquest
into her death, which ended on 2nd June 2011, the jury
returned a verdict of “accidental death” and concluded that the
cause of her death was carbon monoxide from a faulty boiler in the
flat below. The Inquisition completed by the Jury is
available to read here.
The Coroner, Dr Palmer, HM Coroner for the Southern District of
Greater London, decided to report the case to the Department for
Business Innovation & Skills and the Health &
Safety Executive under Rule 43 of the Coroners Rules 2008, inviting
them to consider whether present safeguards are adequate. In
particular, whether it should be necessary to require checks of the
air/gas balance to be made at the time of installation and
commissioning and periodically thereafter at the time of
He suggested tamper-proof valves could be used or sensors
installed to detect faulty combustion and perhaps turn off the
boiler if dangerous levels of carbon monoxide are produced. He also
suggested that amendments are considered in the manufacturer’s
instructions to engineers. A copy of his Rule 43 report is
The manufacturers of the boiler in this case continue to dispute
liability for the tragedy despite the Jury finding “there is no
evidence to suggest that the installation of any subsequent
maintenance of the boiler played any part in the death”.
It is hoped that lessons will be learned so that this type of
tragedy can be avoided in future.
The case was recently reported by
Inside Housing magazine.
Peter Todd of Hodge Jones & Allen acted for the family of
the deceased in relation to the case.