Two-hour blood transfusion delay ‘killed mother who had just given birth to twins by Caesarean’
Is something as simple as a blood pressure test too hard for the NHS?
A mother died after she failed to receive an ‘urgent’ blood transfusion for two hours after giving birth, an inquest was told.
Joanne Hatton lost two litres of blood as she gave birth to twins by Caesarean section at Darlington Memorial Hospital.
But the hospital staff’s failure to give the transfusion triggered a catalogue of errors as her condition worsened, the inquest at Newcastle Coroner’s Court heard.
Despite suffering kidney failure and liver problems after the birth, no one linked her deterioration with the blood loss, her husband, Julian, told the hearing.
The 38-year-old legal adviser only got to spend one day with her newborn sons Ben and Miles before she became seriously ill.
County Durham and Darlington NHS Foundation Trust has since accepted responsibility for the failings.
Mr Hatton, 44, told Newcastle Coroners’ Court doctors and midwives who were dealing with his wife did not communicate properly and that no one person was in charge of her care.
He said the hospital had underestimated his wife’s blood loss after she haemorrhaged heavily following the birth of her sons on December 30 2008.
Dr Ahmed Ali, who has since retired, told the hearing that he had called for an urgent blood transfusion but that when he returned two hours later it had still not taken place.
Mr Hatton later said: ‘It was just like a domino effect. ‘Joanne’s medical condition spiralled out of control after the delivery of the babies and nothing could be done to prevent her deteriorating condition.’
The inquest also heard claims that Mrs Hatton, of Darlington, County Durham, was sent to the hospital’s high dependency unit, rather than the intensive care ward, because of a shortage of beds.
Mr Hatton said he was told at a meeting with the medical director of County Durham and Darlington NHS Foundation Trust that his wife was sent to the high dependency unit rather than the intensive treatment unit because of a lack of beds. At the same meeting, on April 17 2009, he said he was also told that the two units did not communicate effectively about Mrs Hatton’s treatment.
He added: ‘Joanne’s condition following the birth of our twins deteriorated and nobody appeared to link that deterioration with the significant amount of blood that she lost in theatre and when she was being tended to by the midwives. ‘First it was believed she had kidney problems and that these were separate problems not linked to her blood loss. ‘Then the same happened when next it was determined that she had liver problems.
‘Again, it was like nobody linked her deterioration with her significant blood loss. Nobody appeared to be talking to each other. ‘There was a distinct lack of involvement from the maternity unit, which I found very strange at the time.
On January 2, Mrs Hatton’s family were told by a consultant that her kidneys had recovered and that she would be transferred back onto a general ward a few days later.
However, doctors then became concerned about problems with her liver. Mr Hatton received a phone call at 12.30am on January 4, telling him his wife was to be transferred to the Royal Victoria Infirmary, in Newcastle. After ten days of being brought in and out of sedation, Mrs Hatton died on January 20.
Only days before the coroner’s hearing, County Durham and Darlington NHS Foundation Trust accepted responsibility for the tragedy.
The hospital trust said it had made a number of improvements to the high dependency unit and intensive care services.
British passport checks ‘were relaxed 2,500 times’ …and leaks show that private aircraft were ignored
Unbelievable. Open borders Britain. It’s not what the British people want
Passport checks were relaxed nearly 2,500 times at airports this summer, according to leaked UK Border Agency emails. The damning documents also reveal that thousands of passengers on private aircraft did not face passport checks at all and were not screened against the terrorist watch list.
In one email, a UKBA official at Durham Tees Valley Airport raised concerns with managers, complaining: ‘We are not allowed to physically see the passengers arriving on private charter flights. It is creating a situation where we are not able to secure the borders as robustly as we would like, for no justifiable reason.’
In a leaked reply, one manager revealed that this policy was followed at airports around the country.
The revelations will increase pressure on Home Secretary Theresa May, who faces criticism today as former Border Agency boss Brodie Clark is questioned by MPs on the Home Affairs Select Committee.
He resigned last week after Mrs May accused him of taking a pilot scheme to relax biometric passport checks on EU citizens too far by including non-EU passengers.
But Mr Clark hit back, insisting he had been given permission to extend the scheme. Last night, in written answers to the committee, Mrs May admitted the pilot scheme was trialled at 28 ports and airports.
The leaked emails obtained by the Labour Party reveal that level-two checks – the relaxed regime for EU nationals sanctioned by the Home Secretary – were used hundreds of times every week for the 14 weeks the scheme ran between July and November. They show the rules were relaxed 100 times in the first week, 260 times in the sixth week and 165 times in week nine. Averaged out over 14 weeks, that would mean border staff could have abandoned full biometric passport checks 2,450 times.
Official figures show that 2.2million British and EU nationals and more than 300,000 non-EU citizens enter the UK every week over the summer. Between 80,000 and 90,000 private flights, mostly carrying two or three passengers, arrive every year. Pilots on private flights have to file manifest information on their passengers and these details are scrutinised for security threats.
But the emails reveal UKBA staff at Durham Tees had ‘no way of checking whether the handling agent information is correct or even if the number of people arriving on [the] plane matches the number we have been advised’.
An email in June says that staff ‘feel uneasy about an instruction that is creating an unnecessary gap in security which could bring the Agency into disrepute’.
In response, UKBA chiefs said the ‘no-checks policy’ was part of a ‘new national strategy’.
Shadow Home Secretary Yvette Cooper said: ‘This is startling. Last week the Home Secretary told us no one had been waved through without checks this summer. But these documents show passengers on private flights weren’t even seen.
‘Last week the Home Office wouldn’t admit to having figures about how often checks were downgraded. Now we know checks were downgraded 260 times in one week.’
Mrs May last night said that despite the relaxation of checks, figures showed ‘an almost 10 per cent increase in detection of illegal immigrants and a 48 per cent increase in detection of forged documents compared to the year before’.
Don’t push your luck, Britain’s top judge tells Euro court in new ‘rights’ showdown
England’s most senior judge yesterday warned the European Court of Human Rights against interfering too far in British law. The Lord Chief Justice, Lord Judge, said judges in Strasbourg could be about to make the extraordinary demand that British courts ignore laws set down by Parliament. He told MPs and peers that an imminent ruling ‘has huge implications’ and ‘could in effect call on us to disapply the 2003 Criminal Justice Act’.
The looming showdown relates to the case of Imad Al-Khawaja, who was convicted of indecent assault in 2004. One witness gave evidence but died before his trial. A statement she made to police was read to the jury.
Mr Al-Khawaja’s is now a test case over whether criminals can be convicted on the basis of so-called ‘hearsay’ evidence from witnesses who do not appear in court. British law says they can, and the principle has been backed by the Supreme Court. But Strasbourg’s final appeal body, the Grand Chamber, is thought to be likely to over-rule that decision with its own, due shortly.
European human rights judges have regularly ordered Parliament to rethink its laws, as in the ongoing dispute over votes for prisoners. However, they are yet to order courts to actually ignore current statutes.
Lord Judge told the Parliamentary Joint Committee on Human Rights that a decision to overrule the Supreme Court would amount to trespass on British independence and contravene the ‘margin of appreciation’ – the term for how much Strasbourg may interfere in domestic laws. ‘If the decision is that [Al-Khawaja] had an unfair trial, then that decision will be a very good demonstration that the margin of appreciation is not being followed,’ he said.
Lord Judge told the committee that the decision on whose law must be obeyed – that of Westminster or Strasbourg – will eventually go to the Supreme Court. ‘It will have to be resolved,’ he said.
He also claimed that British courts had been following Strasbourg’s rulings too closely. ‘Most of the decisions are fact-specific decisions; they are not deciding any point of principle. They are just saying “here are the facts, here is the answer”. That is not precedent for anything,’ he said. ‘There has been a tendency to follow much more closely than I think we should.’
In addition, the Lord Chief Justice indicated that he fears European Union manoeuvres may remove any opportunity for British courts to defy Strasbourg. At present, the Human Rights Act states that courts should merely ‘take account’ of the court’s judgments.
But the EU is negotiating to use its new constitutional powers, granted by the Lisbon Treaty, to become a member of the ECHR, with the same status as member nations. If it succeeds, the EU’s own European Court of Justice, which sits in Luxembourg, will be able to tell EU countries to follow the judgments of Strasbourg.
Lord Judge said: ‘There is a difference between Luxembourg and Strasbourg. ‘Never mind take account of – we will be ordered to follow Strasbourg law because Luxembourg is following it.’
Starkey: ‘Britain is a white mono-culture and schools should focus on our own history’
David Starkey has provoked more controversy by claiming that most of Britain is a ‘mono-culture’ and that immigrants should assimilate.
The TV historian rejected claims by other academics that it is a diverse country, describing it as ‘absolutely and unmitigatingly white’ outside of London. His outburst comes three months after he blamed ‘black culture’ for the summer riots and claimed that parts of Enoch Powell’s ‘rivers of blood’ speech had been right.
He made his latest comments during a historians conference discussing Education Secretary Michael Gove’s announcement that he wanted to put ‘our island story’ at the heart of Britain’s national curriculum. Dr Starkey told the meeting that the National Curriculum should involve ‘a serious focus on your own culture’.
Cambridge University historian Joya Chatterji asked him to explain what he meant, arguing that contemporary Britain was ‘rather diverse’.
But Dr Starkey cut in, telling her: ‘No it’s not. Most of Britain is a mono-culture. You think London is Britain. It isn’t.
‘Where I’ve come from in Yorkshire, where I’ve come from in Westmorland [in Cumbria], where I largely live in Kent, where I holiday much in the South West, it is absolutely and unmitigatingly white.
‘You have such a series of assumptions. It is a kind of Ken Livingstone-esque view of rainbow Britain. ‘Bits of Britain are rainbow and jolly interesting but to read out from those to everything else is profoundly misleading.’
Dr Starkey added: ‘Successful immigrants assimilate or become bi-cultural.’
Trevor Phillips, Chairman of the Equality and Human Rights Commission, said he did not believe Dr Starkey was racist but was saddened that he ‘feels that he must occasionally utter nonsense that may give comfort to racists.’
Lee Jasper, Chairman of the London Race and Criminal Justice Consortium, tweeted: ‘Starkey the racist academic strikes again.’
Former prison chaplain the Reverend Pam Smith jokingly questioned on Twitter whether Dr Starkey ‘can’t see people who aren’t white’ given the racial diversity of many towns outside the capital.
Richard Evans, Regius Professor of Modern History at Cambridge, criticised Mr Gove and Dr Starkey for advocating ‘myth and memory rote-learning’ to feed children ‘self-congratulatory narrow myths of history’. Dr Evans said school history teachers were right to reflect Britain’s multi-ethnic make up in lessons.
Dr Starkey had been accused of racism by more than 100 viewers of Newsnight in August when he claimed that ‘whites have become black’. He added: ‘A particular sort of violent, destructive, nihilistic gangster culture has become the fashion.’
But Ofcom ruled that the Newsnight discussion had been balanced by other speakers who did not share the outspoken historian’s views.
Another win for systematic desensitization
It’s been around for decades but seems to be strangely neglected as a therapy. It can even be used in at least some cases to overcome that most frightening allergy: peanut allergy
A woman blighted by a severe food intolerance which restricted her to a rice-only diet is preparing for her first Christmas dinner in over a decade. Former caterer Micaela Stafford, 53, lost 3st as her body started violently reacting to foods that included dairy, gluten, wheat, sugars, oils and fats.
She used to enjoy fried breakfasts, curries and roast dinners but was limited to bowls of boiled rice following physical reactions to nearly everything she ate.
Her unusual condition had left dieticians, gastroenterologists and even neurologists baffled. With no solution she was forced to give up her job and became housebound as her condition took control, leaving her husband Philip increasingly concerned.
For the past twelve Christmases she had to watch as her family tucked into their roast dinners while she sat with a portion of bland rice.
She told MailOnline: ‘Every year my condition got worse. The first year it was Christmas pudding that I couldn’t handle and last Christmas I could only manage one sprout.’
But in a dramatic turnaround the mother-of-two, from Normanton on Soar, Leicestershire has overcome her debilitating illness which began in 1999.
After her story gained publicity earlier this year clinical nutritionist Diana Earnshaw got in touch via Facebook and suggested she should try slowly introducing new foods into her diet, and now Mrs Stafford is able to tolerate 40 different foods.
Mrs Stafford said: ‘When Diana got in touch, I thought it was worth a try, I’d tried everything else.’
Following the new diet plan she started by consuming nothing but clear meat broth, made from boiled chicken carcasses which contained only 10 to 14 calories per dish. Eventually she was able to introduce stand-alone dishes, such as omelets and lamb chops, as her body built up resistance.
Now miraculously she is busy gearing up for her Christmas dinner which she will spend with her husband Philip and eldest son Michael, 34. She said: ‘I didn’t believe this would ever be able to happen, I’m really looking for to people coming around and enjoying food again.
‘We are planning on having turkey, sprouts, carrots, green beans, parsnips and potatoes, which will be cooked in goose grease, as this is an oil I can tolerate.
‘Unfortunately there will be no mince pies or Christmas pudding but I might be able to manage some banana and coconut milk.’ She is also on the hunt for a stuffing recipe that will adhere to her dietary needs. ‘There is a local organic farm nearby and I’m hoping they can make me up a special recipe. ‘They have gluten free sausage meat and I’m hoping they can combine it with chestnuts.’
Prolonged migraines, sickness, diarrhoea and joint pains were all symptoms caused by the allergy that remains undiagnosed.
A number of surveys have found that 20 to 30 per cent of people in the UK now claim to have a food allergy.
Mrs Stafford added: ‘I really didn’t think I would be eating Christmas dinner, but now it’s mid November it really seems like a reality. But I still have a long way to go.’