A FATHER spoke of his nightmare last night after an appalling series of NHS blunders led to his wife’s death and left him to bring up their three children.
Julian Hatton watched helplessly as his wife’s condition grew steadily worse – even though she was a patient on an NHS high dependency unit.
An inquest in Newcastle yesterday ruled that Joanne Hatton’s treatment at Darlington Memorial Hospital contributed to complications that led to her death only a few days after her twins were delivered.
The two-day hearing was told how:
• Unexpected delays meant she had had nothing to eat or drink for nearly 24 hours before her Caesarian section operation.
• Despite losing two litres of blood during the operation, there was an unexplained twohour delay in giving her a blood transfusion.
• When doctors realised she was gravely ill, a shortage of beds meant she could not be transferred to the intensive care unit. Instead, she was transferred to the hospital’s high dependency unit, which offered a lower level of care.
• The high dependency unit seemed to be “out of control” with mess and dirty swabs left lying on the floor.
• Medics told Mrs Hatton’s family they thought she could be suffering from HELLP Syndrome, a condition found in one in 1,000 pregnant women which, if not diagnosed and treated, can lead to serious complications and even death.
Mrs Hatton died of multiple organ failure on January 20, 2009, after being transferred to Newcastle General Hospital.
She had suffered a haemorrhage after twins Ben and Miles were born.
Coroner David Mitford also recorded that she had been suffering from HELLP Syndrome and that she suffered an intracerebral haemorrhage as a result of necessary treatment for her condition.
Recording a narrative verdict, the coroner added: “Medical management at Darlington Memorial Hospital of her post-partum haemorrhage, subsequent hypothermia and possible hypovolaemia (blood loss), together with a lack of medical and midwifery communication, contributed to her subsequent medical complications which ultimately led to her death.”
Mr Hatton, 44, who lives in Darlington, said in a statement after the verdict: “To learn the full extent of the mistakes that were made, and which led to Joanne’s death, was incredibly difficult.
“It has forced us to revisit a nightmarish time, when I and my family were helpless as Joanne’s condition deteriorated from one of good health into a virtually comatose state in a matter of a few days.”
Mr Hatton, who now cares for the twins and their older sister, Amelia, six, added: “Jo is missed more than words can say and nothing can compensate for her loss as a wife and mother to our children. I know I speak for my wife’s many friends and the whole family, especially Joanne’s parents, Neil and Barbara, and her brother, David, when I say that we sincerely hope lessons have been learnt from the errors that were made.”
County Durham and Darlington NHS Foundation Trust finally accepted responsibility for the tragedy last week.
During the inquest, Mr Mitford told hospital officials that he would like to see more mandatory staff training and more detailed and regular notes from medical staff.
Trust officials agreed and said that they had learnt lessons from Mrs Hatton’s death. The maternity unit at Darlington Memorial Hospital now has 70 available consultant hours, rather than the 48 which were available at the time of Mrs Hatton’s death.
Mr Hatton’s solicitor, Julia Hurstfield, a partner and specialist in clinical negligence cases at Manchester law firm, Pannone Law, said: “This is a tragic case where a family has been left without a mother to three children, due to mistakes in procedure having been made.
“It is unfortunate that it has taken nearly three years for the hospital to acknowledge negligence.
“The family are pleased that the inquest has recognised the considerable failings that occurred in the treatment of Joanne and are confident that their questions have been answered.
“Julian would very much like to pay tribute to his family and friends.
“The upbringing of his three children is a combined effort from all of them, they have got a very close connection and they are all involved.
“We will now be pursuing legal action on his behalf.”
A spokeswoman for County Durham and Darlington NHS Foundation Trust said: “The circumstances of Joanne’s management have been investigated thoroughly by the trust and as a consequence, changes have been made to the way that obstetric patients who suffer from post-partum haemorrhages are now managed.”
Trust apologises for failures in care
The following is the full text of the letter sent from County Durham and Darlington NHS Foundation Trust to Joanne Hatton’s widower, Julian.
Dear Mr Hatton,
I write in respect of the claim for clinical negligence which you are bringing on behalf of your wife, Joanne.
In the first instance, may I offer you and your family my heartfelt sympathy for your tragic loss.
I also wish to apologise on behalf of the trust for the fact that Joanne did not receive the high standard of care that she was entitled to expect following the birth of your twins.
The circumstances of Joanne’s management have been investigated thoroughly and I would like to assure you that lessons have been learned from this tragic experience.
You are aware, and I believe have seen the Serious Untoward Incident report that was prepared by the Trust following Joanne’s death.
This highlighted a number of issues with the care that she received and as a consequence changes were made to the way that the Trust now manages obstetric patients who suffer from post-partum haemorrhages.
I am aware that you previously met with the Medical Director and Mr Ali, Consultant Obstetrician, in April 2009 to discuss the circumstances surrounding Joanne’s death.
They quite rightly indicated to you at that stage that her care could have been managed better in both the Maternity Unit and on HDU (highdependancy unit).
It was suggested to you then that the hospital would change some of their protocols, and I hope you will find some assurance that this had indeed happened.
I have enormous admiration for the way that you and your family have coped following Joanne’s death and would like to wish you the very best for the future.
I am aware that money cannot in any way recompense you for Joanne’s death, but I would like to give you my assurance that those representing the Trust will be working with your solicitors to achieve a financial settlement to your case as soon as possible.
Yours sincerely, Sue Jacques Deputy Chief Executive/ Chief Operating Officer
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