Investigation Report 201002913

  • Report no:
    201002913
  • Date:
    October 2011
  • Body:
    Tayside NHS Board
  • Sector:
    Health

Overview

The complainant, Ms C, raised concerns that she had not received appropriate care and treatment when she attended Ninewells Hospital (the Hospital) for delivery of her first child (Baby A). Complications arose during her labour and a prolapsed cord occurred. Ms C subsequently underwent an emergency caesarean section. Baby A was born suffering from severe brain damage and died nine days later.
 
Specific complaints and conclusions
The complaints which have been investigated are that:
  • (a) during Ms C’s labour she was not listened to (upheld);
  • (b)  clinical staff wrongly asked Ms C to get off the bed to allow them to clean up a gush of amniotic fluid (upheld); and
  • (c)  the prolapsed cord could have been diagnosed much quicker (not upheld).
 
Redress and recommendations

The Ombudsman recommends that Tayside NHS Board:
Completion date
(i)             
ensure that measures are taken to feedback the learning from this incident to all midwifery staff, to understand the importance of avoiding similar situations recurring; and
30 November 2011
(ii)           
issue Ms C with a formal written apology for the failures identified in this report.
30 November 2011
 

Updated: December 11, 2018