An NHS trust has been fined £800,000 for a “catalogue of failings and errors” that led to the death of a baby 23 minutes after she was born.
Wynter Andrews died in the arms of her parents, Sarah and Gary Andrews, on 15 September 2019 due to a lack of oxygen to the brain, shortly after an emergency caesarean section at the Queen’s Medical Centre in Nottingham.
Nottingham University Hospitals (NUH) NHS Trust had admitted two counts of failing to provide safe care and treatment resulting in harm and loss at a court hearing on Wednesday.
Sentencing at the city’s magistrates’ court on Friday, district judge Grace Leong said: “The catalogue of failings and errors exposed Mrs Andrews and her baby to a significant risk of harm which was avoidable, and such errors ultimately resulted in the death of Wynter and post-traumatic stress for Mrs Andrews and Mr Andrews.
“My assessment is that the level of culpability is high, where offences on Wynter and Mrs Andrews are concerned.
“There were systems in place, but there were so many procedures and practices where guidance was not followed or adhered to or implemented.”
District judge Leong added the “systematic failures” were “more than sufficient” to cause harm to Wynter and her mother.
She said the total fine, combining the sums for offences against both Wynter and Mrs Andrews, would have been £1.2m, but this was reduced to £800,000 due to the trust’s early guilty pleas.
The judge also said she was “acutely aware” any fine would have to be paid out of public funds which would otherwise be spent on patient care.
The trust, which will pay prosecution costs of £13,668.65 and a victim surcharge of £181, has asked for two years to pay the fine.
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Speaking outside the court, Mrs Andrews said she hoped the significant fine “sends a clear message to trust managers that they must hold patient safety in the highest regard”.
She added: “Sadly, we are not the only family harmed the trust’s failings.
“We feel that this sentence isn’t just for Wynter, but it’s for all the other babies that have gone before and after her.”
Mrs Andrews has previously said she was “failed in the most cruel way” by the trust and its management had been “repeatedly warned by staff about safety at the unit” but “failed to act”.
She urged other mothers who may have been through similar experiences to take part in the Ockenden Review, a wide-ranging investigation into multiple failures in maternity care across the trust.
Trust chief executive Anthony May has apologised for the ‘pain and grief’ caused
In a statement, trust chief executive Anthony May said: “We are truly sorry for the pain and grief that we caused Mr and Mrs Andrews due to failings in the maternity care we provided.
“We let them down at what should have been a joyous time in their lives.”
The Care Quality Commission (CQC), which inspects health services in England, rated the maternity unit at the QMC as inadequate, with the hospital overall rated as requiring improvement, when it was inspected last March.
Mrs Andrews was admitted to hospital on 14 September 2019, her planned due date, after an “uncomplicated” pregnancy.
An induced labour planned for 7 September was cancelled on her request, but an investigation later found this was signed off by a midwife without consulting an obstetrician, and limited reasoning was given for the decision in medical notes.
Once Mrs Andrews was in labour, Wynter’s heartbeat was described as “suspicious” by doctors, who decided to deliver her via caesarean section.
After complications during the surgery, she was delivered in a “poor” condition and died 23 minutes and 30 seconds later despite “extensive efforts” to resuscitate her.
