Inquest into a baby death highlights hospital failings

15/11/2010

Joint head of the clinical negligence department, Patricia Fearnley acted for the parents of Hebe Carr whose inquest was held by North West Kent Coroner Mr Roger Hatch at Gravesend on 11,12 October and 2,12 November 2010. At the inquest Mr and Mrs Carr were represented by Lucy MacKinnon of Hailsham Chambers, instructed by Thomson Snell & Passmore.

Mrs Carr gave birth to her baby daughter Hebe on 26 June 2008 at Pembury Hospital near Tunbridge Wells. Mrs Carr suffered a placental abruption and Hebe was born in an extremely poor condition. Hebe sadly died the next day. 

Mr and Mrs Carr have had strong concerns about the standard of care provided at Pembury Hospital. Despite these concerns Maidstone and Tunbridge Wells NHS Trust's own investigation concluded that there was no case to answer. However, HM Coroner instructed an independent expert to give evidence who concluded that Mrs Carr was left to labour largely unsupervised and that she should have been more closely monitored.

Mr and Mrs Carr's first daughter, Josie was born 3 months prematurely at Pembury Hospital in 2003 by emergency caesarean section. Mrs Carr suffered a massive placental abruption which placed her own life and that of he baby at risk. Thankfully, Josie survived. The decision to have a second child was not an easy one and Mr and Mrs Carr were extremely worried throughout the pregnancy with Hebe about recurrence of abruption. They do not feel that their concerns were taken seriously during Mrs Carr's antenatal care. 

Mr and Mrs Carr are relieved that their persistence has led to a thorough investigation by HM Coroner and that the jury have found that Pembury Hospital have been responsible for a catalogue of serious errors in Mrs Carr's care.

In their verdict given on 12 November the jury found:

• that Hebe died from lack of oxygen during birth due to placental abruption.
• that the doctors failed to take into account Mrs Carr's previous complications when giving antenatal advice
• that had they done so Mrs Carr would have elected to have her baby delivered by caesarean section.
• that had Hebe been delivered by caesarean section she is likely to have survived.
• that staffing levels at Pembury Hospital when Hebe was delivered were inadequate and that this contributed to Hebe's death.

The jury also commented that there had been a lack of communication between staff and between staff and Mr and Mrs Carr both before and after delivery.

Whilst the Coroners Rules prohibit an inquest verdict from attributing civil liability is is open to the deceased's relatives to rely upon evidence that emerges during an inquest when pursing a subsequent clinical negligence claim.

Patricia Fearnley is a solicitor specialising in medical negligence cases.