Meeting date of enquiry into Bo's death has been set. I need help in handling this. This is a long post.(93 Posts)
The Head of Maternity Services 'phoned today. The doctors, midwives and trust officials have reviewed my notes, are having another meeting next week to investigate further evidence and will then meet with Mr Bubble and I on the 29th April.
I know that some of you have followed my posts, from my excited ramblings prenatally to the sad, sad posts after the awful event and since. I thank you all on behalf of the whole Bubble family for all of your words of love and support. You have no idea how much they have helped when I have been unable to get out of the door, let alone speak to anyone in RL.
It's said that time is a healer. After Bo died the pain was beyond belief. Physical pain. My heart was literally broken. It's said that time heals and to some extent this is true. It makes the pain bearable but I don't think I can ever fully recover from losing my healthy term baby because of the actions of others. Not God, others.
We now will face the enquiry where we will hear a blow by blow account of my son's last hours. I need to establish what I want from this meeting. I think I can summarise as follows but I'd appreciate any input/ideas from all of you. Mr Bubble and I want to make sure that nobody goes through what we and Bo have suffered. You may be that person, so it is important that I go into this meeting with clear ideas on what needs to be done. My thoughts are as follows:
1) The MW notes from my booking appt ended with "Needs consultant appt" - no appt was ever arranged until my GP wrote to her at 30 weeks gestation. None came and I made one myself at 36 weeks.
2) At 37 weeks I took myself to hospital with headaches, 2+ protein in urine (self tested) and swelling. I was discharged after 24 hour urine collection. Results of which showed high levels of protein but were reviewd at 38 weeks in ante natal clinic and deemed OK.
3) After sweep at 38 week ANC MW booked me for induction at 39 weeks. When we arrived at the hospital the reception staff had no record of our booking and we were put into a room on the post natal ward. Had the ANC MW informed the mternity unit about our induction appt?
4) MW's on post natal ward did not seem to understand the seriousness of the CTG traces. Were they experienced enough to understand or were their skills "rusty?"
5) Were there enough staff on duty?
6) When the consultant on call 'phoned to see if thre were any cases he needed to know about and was not told about me, did I slip through the net because I was on a post natal ward. Did he 'phone the ante natal ward only. Why would he 'phone a post natal ward?
7) When the MW's from labour ward came to assess me why did none of them realise that the babies were extremely tachycardic and in distress?
8) Why did same MW's allow attending doctors to perform amniotomy and attempt vaginal delivery even though both babies were in distress?
9) When we eventually got to theatre why was it down to me, the patient, to tell the anaesthetist to abandon attempts at epidural anaesthesia and give me a GA? Why didn't the doctors or MW's speak out?
10) Why was my cervix not assessed for dilation until 03.30 am (seven hours after I was admitted) even though my notes clearly stated that I had had a show 3 days before admission?
We want to know that procedures are in place to prevent this happening again. How can I know that this has been done? What tangible proof can I expect/ask for? We don't want to be fobbed off with words and promises. If changes are to be made that require extra funding, how can we make sure that the extra funding is provided from above and that the maternity unit will not be expected to fund changes from their already overstretched budget?
Can we tape record the meeting, I know that I will be too upset to take it all in and I'll need to review it. I this allowed?
Bubble - I'm afraid I don't really have anything useful to say, or add - but I'll be thinking of you and hope you get the answers you need
I cant really answer any of your questions but from one mum to another, I sincerely wish you the best of luck and commend your bravery in stopping this happening again.
Im not going to pretend I know how you feel Bubble as I have not gone through your trauma but what I will say is that I wrote a letter to my mat hospitals officials over the management of my labour (which turned out fine) and I had a representative from our local Community Heath Council attend a meeting between myself and the officials and consultant in charge of me. They all came to my house and we discussed my letter and complaints. They made formal apologies on 4 counts and wrote confirming it. As I said, it is nothing like what you have suffered but would suggest that you speak to your GP or CHC representative to join you in the meeting as it is going to be very emotional for you and Mr Bubble. Also i think you can tape record but only if you make them aware before doing so and they have no objection.
Best of luck, bubble. I hope this meeting is everything you want and need it to be.
Bubble, all my support to you and your family. I believe that tape recoding the meeting should be allowed, but that a recorder always make people uneasy and then, they maybe over careful with their responses resulting in a less informative meeting.
Is your solicitor coming with you, is there any neutral part in the meeting? I really don't know about this things but I would suggest to focus in what you want to get from the meeting: If you want the procedures of the hospital to be reviewed be open about it, if you want to get some indemnisation say it, where do they get the money from is to a certain extent their probblem, and eventhough that money may come form other very needed NHS projects, bear in mind that by sueing them you are also teaching them a lesson, don't feel as if you were asking for a revenge, people can learn more from their mistakes if they have to pay a higher cost, and if it takes for them to be sued and strained for money for some things that will also teach them to be more careful in the future and to set procedures that could prevent your history from being repeated. If the cost for them to learn to be more careful is that,IMHO is money well spent.
I would suggest you allow them to speak as much as they want first, if you have answers write them down and ask them until they have finished talking, that gives you a great advantage on the negociation.
If they tell you they are going to do something ask for a date and the name of the person you should contact to review the situation regarding that issue. Ask also what it is the direction to follow in case they have not managed to get to an agreement regarding your case.
HTH, a very big hug.
All the best bubble. I don't have anything to say at this time but I do remember someone saying that you should keep a copy of your posts on MN to help you remember all that went on. I'll be thinking of you and Mr Bubble and your boys.
Best of luck Bubble - I'm sure this is going to be very difficult for you and Mr B, but I do hope the meeting is the first step to the answers you both need and to any future changes in policy.
I have no idea about recording but I do hope that you are allowed to have someone there with you and at the very least there should be someone you trust taking full notes.
Hi Bubbles, this is the first time that I have posted on your message thread although I have read with such sadness your postings . You detail with such clairty the events leading up to the loss of Bo. Maybe a suggestion would be to submit a letter with all of the points that you have detailed here insisting that you want answers for your meeting on 29th, this then puts you and Mr B in the driving seat and will help YOU get what YOU want and NEED from this meeting, which will, I'm sure. be a traumatic experience for you both in itself. I will be thinking of you both on 29th. love to you all
I don't know if it will help you at all Bubble, but the thing that has really struck me about your hospital experience is this if this level of incompetence can happen to a midwife/nurse- what if a non medically trained person had gone through this, what if it was someone like me who doesn't know the significance of CTG traces, who doesn't recognise foetal distress, and therefore wouldn't know to shout out and make them take notice? If you hadn't done all this due to your training, what would have been the outcome? it makes my blood run cold and could be worth asking the head of maternity this question for the sake of others under their care. All the best of strength to you for the meeting.
This was my first thought and it maybe a daft one, so apologies.
Do you know anyone who takes short hand ??
There must be some one out there with excellent skills who could take impartial notes for both sides.
I agree with Chandra, that a tape recording may make people a bit more wary.
Why not do a post and see if anyone on here can help, there must be a legal secretary amongst the skill base here.
I have been following your sad posts and did not realise until now that you had suffered pre-eclampsia? Apologies if I am wrong. I wondered if APEC (Action against Pre-Eclampsia, a Charity for support of suffers) may be able to help or advise?
http://www.apec.org.uk/home.htm They have got some health officials listed but it actually specifies that they will not get involved in any legal issues . Could you speak to the Lawyers of the couple that also lost their baby in tragic circumstances?, as I think you mentioned that you may use the same one. I really think you need to get some Legal advice on what to do here as reading this as a total layperson, it appears that the Hospital were negligent on quite a few counts. There is training given to health workers to spot the tell-tale signs and so should be no excuse of why they didn't.
As LGJ says there must be a Legal Person within MN?
I agree with LGJ - a neutral but trusted party taking copious, accurate notes may be less confrontational than taping the meeting.
I think your post here sets everything out clearly and I think you can do no more than set out your aims and objectives to the hospital in the same terms. You will know more after the meeting about what exactly went so wrong and will be drawing your conclusions. Then you will be in a position to press for change where it's needed. Try not to see this meeting as a one-shot opportunity to get accross everything you need to - the hospital owe you more than one meeting about this if needed.
Bubble, I've read your posts over the last few weeks and have cried alot on your behalf at this utterly unbearable loss. I truly hope you get some of the answers you want on the 29th and wish you and your family all the very best.xx
No extra advice to add, but wanted to wish you well in the inquiry.
Will the enquiry be recorded anyway and a transcript made? I ask because I once applied to work for a company that made transcripts for enquiries (not medical to my knowledge) but I sort of assumed they would need a complete record of everything that was said, rather than just notes.
I think I'd suggest buying one of those small dictaphones (they're readily available and quite cheap) and taking it with you, at the beginning of the meeting, just say you are going to tape this meeting as you do not want to miss anything and you assume that there will be no objections.
Taking a professional note-taker sounds like a good idea too, somebody like a court reporter would be a good idea so you don't miss anything
Are you going to ask why your repeated requests for intervention were ignored by all
I think I would ask for an agenda of the meeting at least a week in advance for you to consider and feeback on
You have my continued support and thoughts
Oh Bubbles. I say take the tape recorder. quote the fact that people recieving bad news only hear 30%(is it?) of words spoken to them. Tell them this is a vital part of your grieving process to try and discover why. Explain that you are not taking the recorder to be confrontational, but just for your own peice of mind. I'd be shocked if they refused and would want to ask what they feel they have to 'hide' from you that it can't be said on tape. Ring ahead and check and see what they say so if not you could arrange a scribe.
The whole thing sounds like one mistake or oversight after another. I just wonder whether any one person will be found accountable or whether it will be attributed to a very sad chain of events. I don't know whether you feel someone should be blamed or if you just want to know the hospitals version of what went wrong to try and appease your grief in some way. i just hope so very much that you find this meeting helps you and mr Bubbles, if only at the very least for you to completely understand that none of this was your fault. Hugs to you all. xxx
very good point sobernow... start from when you got to hospital.. fewer people for them to pass the buck to that way
Bubbles, I too have little to add, other than to wish you all the strength you need get through this next stage. I hope you get the answers you need.
This link might be useful.
i've racked my brains, but really can't think of much else to add.
just one thought - have you been in contact with AVMA at (association for victims of medical accidents). their web site is at www.avma.org.uk
Looking at the website, it appears that local branches of avma might be able to supply people to accompany you to meetings - wonder if that might be of any use to you re:note taking.
if you do go for taping the meeting, I would be happy to assist in typing up the tape if that is any use.
Bubble I have nothing to add over the excellent advice you have been given here. Your story is especially sad to me as around the same time you lost Bo one of my best friends lost her baby through medical negligence.
Brief story is this was her 3rd preg, she had had abruptions and 2 emergency sections previously so was being monitored very carefully including weekly scans. She had gest diabetes and a number of bleeds that had caused her to be admitted to hospital, she was desperate to make it to 38 weeks to be induced. Despite begging them to induce her early they stuck to 38 weeks. On the day it took the surgeon way too long to get the baby out, the baby was wrapped up and given to her father as standard. It was only after 2hrs 40 mins that my friend noticed the baby was pale and struggling for breath that they took her to the SCBU. It was then discovered that my friend had had placenta previa and the surgeon has nicked the placenta going in and the baby had lost 60% of her blood volume. On SCBU it was too late and her major organs failed and she died aged 3 days. My friend has loads of questions too namely why was the placenta previa never picked up despite the fact she had over 30 scans and if he surgeon had cut the placenta on the way in was the baby not transferred immediately to SCBU (a consultant paed has said if she had been transferred straight away she might have survived).
I know this does not help you bubble in your case but she her enquiry is coming up soon and I hope both of you get some sort of admission of guilt and therefore justice for losing your precious babies.
bubble my dh is a clinical negligence lawyer, I will print this off and ask for his advice.
Bubble - Leigh & Day (leading medical negligence lawyers) have a really useful website. See here for more information on what you can hope to achieve via the various alternatives to a legal case.
Bubble - really thinking of you & family. Is there a labour ward/maternity unit protocol booklet you could have. As I understand (I'm not medical) this document should detail what is to be done on labour ward in different situations. If I'm wrong on this then my apologies as I don't want to take up your time unnecessarily. I'd tape the meeting - even video tape it if necessary. Plus have the legal team there. Having someone take shorthand is also good so that you can review what was said afterwards - or get someone to transcribed the meeting from tape afterwards. Words really can't express how shocking what has happened is - please stay strong - you will get through this, you will get the answers.
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