Baby’s maternity unit death ‘preventable’

Royal Oldham Hospital: “catalogue” of errors

A CORONER has ruled that the death of a four-day-old baby boy was “preventable”.

Dylan Harrison Oates was the victim of neglect by staff at the Royal Oldham Hospital, his death following a “catalogue of errors”, an inquest found.

Mum Jayne Oates, of Littleborough, was admitted on January 14, 2014 and the birth of her first baby, Dylan, was induced because she was overdue. Dylan was born two days later, but lived only until January 20 due to “errors and omissions” by maternity staff.

He was one of seven babies and three mums to die at the Royal Oldham and North Manchester General Hospitals within eight months, which led to an external investigation.

An inquest at Heywood Phoenix Centre heard the hospital’s labour ward was “frenetically busy” when Mrs Oates was admitted. Over the next two days she was given three doses of the drug Prostin to induce the birth, the third of which was given without the usual review by a doctor. She was also transferred to the hospital’s birth centre, contrary to the usual procedure.

Coroner Lisa Hashmi found staff had failed to follow guidelines and efficiently monitor Mrs Oates and the baby, which led to them missing irregularities in his heartbeat. She also criticised several decisions made regarding Mrs Oates’ care.

Further failings noted included poor midwifery leadership, poor staffing levels and ambiguity in the trust’s guidelines.

Mrs Hashmi said: “That catalogue of errors and omissions is something the family have paid the price of.”

When Dylan was born, he was not breathing or crying and was taken into intensive care. He became “less and less responsive” over the next two days and Mrs Oates and husband Martin were told he had suffered severe brain damage and wouldn’t survive.

Recording a narrative verdict, Mrs Hashmi said the failures by the hospital constituted neglect to Mrs Oates and Dylan. She added: “In my view, Dylan’s death was preventable.”

Representing the family, Helen Nieburgh, of Darbys Solicitors, added: “Dylan Oates’s death has devastated his parents and family. They have lost their beautiful baby son and hope the tragedy of his death and the recommendations the coroner has made may help to save the lives of mothers and babies at Pennine Acute Hospitals NHS Trust in the future.”

After the inquest, Chief nurse Gill Harris said significant changes have been made since Dylan’s death.

She said: “This is a desperately sad case and I would like to reiterate our sincere apology and express our sympathy to baby Dylan’s parents, Jayne and Martin, and their family for their loss.

“We fully accept the coroner’s findings and would like to apologise for the failings and substandard care afforded to Dylan and his parents.”