A coroner has tragically found that a baby would have survived if he had been delivered just 20 to 30 minutes earlier.
Hospital failures led to the death of baby Casey Garrett just seven hours after he was born said senior coroner for Bedfordshire Thomas Osborne.
He is now questioning whether Bedford Hospital should be used for the training of student midwives and will be writing to the body responsible for overseeing this.
At the end of a two day inquest, held on Monday and Tuesday this week at Ampthill, Mr Osborne returned a narrative verdict saying: “Prior to his delivery at Bedford Hospital there were a number of failures to recognise that his condition was deteriorating and there was a failure to escalate the levels of care so as to expedite his delivery.
“These failures resulted in a lost opportunity to deliver him earlier and avoid his death. He died on 11 September 2015 at 7.10am from perinatal asphyxia.”
The coroner will also be meeting with the hospital’s chief executive to ensure safe procedures are being adhered to.
Casey’s mother, Anna Garrett, was admitted to Bedford Hospital on September 10, 2014 for the birth of her first child. The baby boy was born later that evening but was not breathing. He was resuscitated and transferred to the neonatal unit, but died seven hours later in his parents’ arms, after being christened by a priest.
The hospital trust carried out an internal inquiry identifying several failings including breaches of its own guidelines, in particular a failure by the midwives to call for medical assistance when there was, amongst other things, lack of progress in the second stage of labour and failure to interpret the baby’s heart rate properly.
Speaking after the inquest parents Dean and Anna, of Bromham, said: “We feel very let down by the staff at Bedford Hospital who we had placed the utmost trust in. However, we feel that Casey’s death has been a pivot for change and agree with the coroner that his short life has and will make a huge difference to the safety of patients. We could not have wished for a more open inquiry.
“We are both so very grateful for the short time we spent with Casey. He was the most beautiful baby boy and he changed our lives forever. It is true that the smallest footprints have the power to leave an everlasting imprint on this earth, only Casey left his deepest footprints in our hearts.”
Julie Say, medical negligence lawyer at Hodge Jones & Allen and Sebastian Naughton, Counsel of Serjeants’ Inn Chambers represented the family. Ms Say said: “This has been one of the most open inquests that I have attended and one that has been a force for change with all interested parties working toward improving patient safety. Anna and Dean have felt that all the concerns that have troubled them have been aired in public”
A statement released by Bedford Hospital NHS Trust following the hearing said: “The Trust deeply regrets the tragic death of baby Casey and we would like to extend our sympathies and apologies to the parents at this very difficult time.
“Following detailed external investigations, commissioned by the Trust, we have implemented a range of recommendations to help prevent such a case from happening again in the future. We will continue to undertake further work to ensure these actions are fully embedded.
“The Trust accepts the Coroner’s conclusions.”