Violet Stephens died at Queen’s Hospital, Romford due to ‘serious failure’
A mother died after giving birth due to a “serious failure” by doctors at Queen’s Hospital, a coroner ruled.
Violet Stephens, 35 from Brentwood may have lived if she was given a caesarean section earlier, Walthamstow Coroner’s Court heard on Thursday February 16.
Instead the mother-of-two who was 31 weeks pregnant with her third child had to wait three days after being admitted because consultants didn’t hand over her care and missed earlier opportunities to deliver the baby.
When she did undergo the emergency C-section, Violet, who had a history of pre-eclampsia and HELLP syndrome in her past pregnancies, had a two-and-a-half hour delay before she was given an urgent blood transfusion.
Independent expert, Dr Susan Bewley sad: “We know that pre-eclampsia is a very aggressive disease but I think her chances of survival would have been better if action was taken earlier.”
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Her cause of death on April 9 last year was given as multiple organ failure.
Violet’s child Christian, a baby boy lived.
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Violet came into hospital on April 6 complaining of chest, rib and back pain.
She was suffering from pre-eclampsia, a condition that causes high blood pressure in women and babies during pregnancy.
Two days after arriving she had to wait between 10 to 15 minutes before she could be moved into the labour suite because it was being cleaned.
There was a further seven minute delay because the nurse didn’t want to leave the ward short staffed.
Violet got into the labour ward at midnight and was given a caesarean section at 4am on April 9.
But her condition had already deteriorated and despite attempts to save her, she died.
Sarah Harman, representing the family, said: “This was a hospital that was struggling with too many mums delivering too many babies and there were capacity issues, this was not a hospital that was working with the peaks and troughs that all hospitals can deal with, but it was so full that no one could take a breather.”
Violet’s sister, Kitty Mhango who is a midwife and a sister, said: “Now that I know what happened during my sister’s death and the matter has been investigated, my family and I can finally put the matter to rest with the assurance that nobody will go through what my sister went through.”
Coroner Chinyere Inyama recorded a narrative verdict and said that he would be passing on his findings to the Care Quality Commission.
Chief executive of the Barking, Havering and Redbridge NHS Trust, Averil Dongworth, said: “The trust fully accepts the inquest verdict and I would once again like to apologise to Ms Stephens’ family for their loss.
“We are determined that lessons are learned from Ms Stephens’ death.
“We have made extensive changes to our maternity services over the last year. “We have increased consultant cover out of hours and have the highest level of consultant obstetrician cover in a labour ward in London.
“We are working with trusts across the capital to manage capacity so that women can be given dedicated one-to-one care in our hospitals.
“We have also hired more than 100 new midwives, extra consultants and have retrained staff.
“Systems have been improved and new ways of working introduced, to ensure that women receive the safe, high quality care they deserve.”