Schoolboy's 'killer' food unknown, inquest finds
A boy who died after eating his school lunch suffered fatal anaphylactic shock probably caused by food, an inquest jury has concluded.
But, giving a narrative verdict, jurors found the allergen behind Mohammad Ismaeel Ashraf's death was unknown.
The jury had heard the Birmingham pupil, nine, ate fish fingers, although medical experts told proceedings it was "unlikely" he died from his lunch.
Care plans for children with allergies at Al-Hijrah School have been queried.
Coroner Louise Hunt said she was concerned proper provision had not been in place for all children with special dietary needs.
During the hearing at Birmingham Coroner's Court, the jury was told catering staff had never looked in the "red book" kept in the kitchen area listing children with allergies and containing care plans for each of them.
Rather, jurors heard, staff simply "got to know" the children concerned, although a caterer said she was "shocked" when, after Ismaeel was taken ill, she checked the book and saw his full list of allergies.
The court was also given conflicting evidence about Ismaeel's needs.
The school said its notes indicated he had a fish allergy, although his father said eating white fish had not posed a problem.
Jurors heard a delay in school staff administering an emergency adrenaline injection may have "contributed" to his death.
Dr Robin Tall, consultant paediatrician at Birmingham Children's Hospital, said: "It [the adrenaline] was given later than it should have been. It is not negligible".
The court was told that on the balance of probabilities "it did contribute" to Ismaeel's death, although was not the "cause".
A statement from the school said it "takes its responsibilities to ensure the safety of its pupils very seriously" and "has already learnt lessons and made changes to the way it manages medical conditions in school as a result of this tragedy".