A case in which I advised the parents of a four-day old baby who died in 2012 after being deprived of oxygen has recently been in the news as the family has only just received a five-figure settlement and an apology from Warwick Hospital.
An inquest, held in June 2013, heard how failings in Daniel’s care during labour had led to his death. These included three different midwives failing to read his mother’s antenatal notes which would have revealed her as a medium risk patient; one of the midwives having a history of making mistakes; and a failure by staff to monitor the foetal heart properly.
The testimony of Sarah Kunigiskis, mother of baby Daniel, makes harrowing reading. In addition to the grief of losing her baby was the refusal of the hospital to admit they were at fault while implying that there was something wrong with the baby before delivery. As she noted, the refusal of the hospital to acknowledge that a catastrophic error had occurred, made an awful situation far worse. One of the reasons Sarah was willing to speak out was to help put pressure on hospitals and NHS Trusts to be more accountable for their actions when mistakes are made by encouraging others in similar situations to challenge the experts if they feel things are not right.
NAO report into maternity services in England
The situation endured by the Kunigiskis family is not unfamiliar to medical negligence solicitors. Obstetrics is a particularly challenging area of medicine where there is, on the one hand, a desire not to medicalise a perfectly natural event but, on the other, a need to step in as soon as things start going wrong. A report released by the National Audit Office in November 2013 highlighted that some of the problems faced by maternity services in England were reflected in the fact that a third of the NHS litigation budget was absorbed by medical negligence cases relating to birth complications. In 2012 there were almost 700,000 live births, the highest rate for 40 years, putting considerable pressure on resources. There has also been a noticeable increase in the number of ‘high risk’ births including multiple births, women over 40 and women with obesity or pre-existing medical conditions. Although mortality rates have improved, the NAO report noted that there were ‘wide, unexplained variations in the performance of individual trusts in relation to complication rates and medical intervention rates, even after adjustment for maternal characteristics and clinical risk factors’.
Need to improve safety
The number of maternity-related medical negligence claims increased by 80% in the five years to 2012-13 resulting in a litigation bill for maternity claims alone amounting to £482m in 2012-13. This figure represents about a fifth of all spending on maternity services which is a sobering fact by anyone’s standards. The NAO report flagged a number of areas which might help to explain why medical negligence claims were so high: more than half the obstetric units in England did not have the number of consultants on site as recommended by the Royal College of Obstetricians and Gynaecologists; and midwife staffing levels fell below that recommended by a national benchmark of 29.5 births per midwife. In order to achieve this ratio, another 2,300 midwives would need to be recruited although even this would be further complicated by the fact that a large number of midwives were reaching retirement age and a growing proportion of student midwives were failing to complete their courses.
More cooperation, better data
Although the Kunigiskis case is by no means an isolated incident, and despite the upward pressure on maternity services generally across the country, most women do have positive experiences of giving birth in a NHS hospital. However, there is clearly scope for major improvement, not least in order to reduce the phenomenal amount being paid out in medical negligence claims. Among the NAO recommendations is a call for more and better data on maternity services in order to track trends, outcomes and experiences; and clinical commissioning groups should look at how services are delivered in their area and look to cooperate with neighbouring trusts to ensure all available resources are used efficiently. Last but not least, hospitals need to own up to mistakes at the outset and endeavour to give the families a full explanation of what went wrong. It is the very least they can do and might even help to reduce the number of claims made against them.