Midwife’s blunders cost life of our
inability to learn from mistakes had “condemned my daughter to death”, adding: “How has this been tolerated for so long? It is horrific.”
Mrs Stanton-Davies, whose baby died after delays in transferring her from a community hospital to a doctor-led maternity unit, said: “I am going to push for the police to bring a charge of corporate manslaughter.”
Mrs Stanton-Davies, from Hereford, believes the review team still do not have case notes relating to hundreds of concerns raised about the trust.
“We do not know the scale of it even now,” she said. “I just want the police to move in and step in.
“We have been fighting as a family for 10-and-a-half years. It’s frustrating and it’s stressful, but we are fighting to save babies’ lives in our daughter’s name.
“I don’t trust anyone else other than the police now – there have been too many false promises for too long.”
The trust, which runs Royal Shrewsbury Hospital and Telford’s
PARENTS Rhiannon and Richard Stanton-Davies have fought for almost 10 years to get justice for their daughter Kate, who died just hours after being born.
Their battle helped launch the inquiry into the scandal-hit NHS trust and almost exactly a year ago a misconduct case was proven against midwife Heather Lort over the care of their baby.
A Nursing and Midwifery
Princess Royal, apologised unreservedly to families affected but said a “lot has already been done to address the issues raised by previous cases”.
However, the report being drawn up by maternity expert Donna Ockenden warned lessons were not being learned and staff were uncommunicative with families.
She said: “No apology will be sufficient or adequate for families who lost loved ones to avoidable deaths, or whose experience of becoming a parent was
Council panel found Lort made “significant record-keeping errors” and “failed to recognise Kate’s health was compromised at birth”.
She did not provide “effective resuscitation” to Kate, who was born at Ludlow Community Hospital on March 1, 2009. She also did not make sure the baby’s vital signs were monitored after she was noted to be “grunting”.
Donna Ockenden warned that lessons were not being learned
The panel concluded her “practice [was] impaired” due to “misconduct”. It concluded her misconduct was so serious it led to a loss of chance of survival for Kate, who died hours after she was born.
The panel was told Lort, who no longer works for the trust, admitted serious failings in her care of another baby who was stillborn in 2013. The only way to prevent a repeat of her misconduct was to strike her off, blighted by poor care and avoidable harm. Many families have described to me how they live on a daily basis with the results of that poor care.”
In one shocking case parents were not told their baby’s body had arrived back from the post-mortem examination and it was left to decompose so badly the family never got to say a final goodbye.
The Care Quality Commission health watchdog currently rates the trust inadequate and raised concerns about safety and how it is led.
A probe into avoidable baby deaths was ordered in 2017 by then health secretary Jeremy Hunt. it ruled. The decision was made last year, nine years after Kate’s death, which her parents said had been “torturous” but the ruling provided justice for their daughter.
A jury inquest in 2012 and an investigation by the Parliamentary Health Service Ombudsman in 2014 both concluded Kate’s death was avoidable and the result of serious failings in care.
The inquest found the child
The initial scope of Ms Ockenden’s report was to examine 23 cases but this has grown to more than 270 covering the period 1979 to the present day.
Cases include 22 stillbirths, three deaths during pregnancy, 17 deaths of babies after birth, three deaths of mothers, 47 cases of substandard care and 51 cases of cerebral palsy or brain damage.
The interim report details indescribable pain suffered by the families, including babies left brain-damaged because staff failed to realise or act upon signs that labour was going wrong.
It found there was a failure to adequately monitor heartbeats