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Guy's and St Thomas' Hospital

Arti Shah has successfully concluded a clinical negligence claim for a six figure sum against Guy's and St Thomas' Hospital. Sadly, due to the treatment Ana Maria Ene received in the latter stages of her pregnancy, her son, Alexander, was delivered stillborn on 3 March 2017.

Ana Maria underwent IVF treatment in mid-2016, and was advised it had been successful. She was given a due date of 13 March 2017. Her pregnancy was complicated by a kidney issue and polyhydramnios, a condition where there is too much fluid around the baby.  She had extra ultrasound scans as a result, and an induction of labour was planned at full term.

At 38 weeks, on 27 February 2017, Ana Maria rang the hospital as previously discussed, and was advised to attend in the afternoon. She was admitted, scanned and a CTG was commenced. She was given prostaglandin to induce labour and advised to wait 24 hours.

The following afternoon, 28 February 2017, she was seen by a midwife who commented that, from reading the CTG trace, Ana Maria could be giving birth the same day. A further CTG was commenced later that evening and noted to be normal, despite there being loss of contact on multiple occasions. Ana Maria was not checked on during the night.

The next day, 1 March 2017, Ana Maria asked both her attending doctors and midwives of the possibility of a Caesarean section. She was concerned that Alexander was much more active than usual. This was dismissed by staff and a registrar instead told her she needed more prostaglandin, which was applied via Prostin gel.

Later that evening, she was assessed by a midwife. The CTG was recorded as being normal, but Ana Maria was experiencing severe labour pains. Artificial rupture of membranes (ARM) was suggested but in fact could not take place as Ana Maria had not dilated enough.  

On the morning of 2 March 2017, Ana Maria was seen by a Consultant on a ward round. She was exhausted and again requested a Caesarean section, but was told this was not necessary. There was no discussion of options. Instead, Ana Maria was given a further dose of prostaglandin and told to wait a further 24 hours.

A doctor did not visit again until closer to midnight, when Ana Maria was advised induction of labour had failed. She was given 2 options:

(a) to wait and start again with an induction of labour;

(b) Caesarean section

Despite confirming her wish for a Caesarean section which she had already requested a number of times previously, and in circumstances where there had been little cervical dilatation, Ana Maria was persuaded to have an attempted controlled ARM in the morning. She was advised that if this did not work, she could then have a Caesarean section. By now, Ana Maria was completely exhausted on her third full day of labour.

Ana Maria had a sleepless night. Overnight, she noticed irregular fetal movements which she brought to the attention of the midwives as being unusual for Alexander. Further, there were multiple occasions of loss of contact with monitoring. She was advised that there was no such thing as a baby moving too much, and reassured that the CTG was fine.

The following morning, 3 March 2017, Ana Maria had prepared for theatre as agreed. However, she was advised that the labour ward was extremely busy, and no theatre was available. In addition, no continuous monitoring was being done, and the last recorded CTG trace is timed at 11.26am. Distressingly, this last section of trace went missing from Ana Maria's case notes. No further monitoring was done.

Despite regularly requesting an update about theatre availability and when she would be delivered, Ana Maria was not taken to theatre. In the late afternoon, she was told there was a possibility that Alexander would not be delivered that day. Ana Maria was distraught.

At 4.32pm, Ana Maria was seen to by a midwife. Sadly, she could not detect Alexander's heartbeat. A doctor was called to confirm the findings, and devastatingly confirmed Alexander had died during the wait.

Distressingly, Ana then had to deliver Alexander. This was the first time her request for a Caesarean section was listened to without discussion. Alexander was delivered stillborn at 9.36pm that evening.

The Trust launched an internal investigation into the matter soon after, which was critical of the treatment received by Ana Maria during her induction process. The report acknowledged that there had been a "significant opportunity! To change the outcome in this case, and that if Ana Maria had been taken to theatre and Alexander delivered earlier, he would have been born alive. This was a very difficult report for Ana Maria to read.

Arti investigated the case on behalf of Ana Maria. She sent a Letter of Claim shortly after being instructed, and in November 2017, the Defendant admitted breach of duty and causation. An early offer of settlement was made by the Trust but rejected.

Arti commenced investigations, including obtaining expert evidence from a fertility specialist, and prepared a comprehensive schedule of loss, allowing the parties to enter into sensible pre-action settlement discussions.

Arti settled the claim on behalf of the client for a six figure sum, 15 months after being instructed, and 5 times the value of the first offer made on behalf of the Trust.

After the case concluded, Ana Maria sent a touching photo from Alexander's funeral and said:

"The decision to take legal action against the hospital further to the stillbirth of our son Alexander in March 2017 was a very difficult one. Neither one of us have done anything like this before, but after approaching Fieldfisher and meeting Arti for the first time, we felt that we’re in good hands and have been put at ease with what could have been a painful experience to go through. 

Arti did a wonderful job from start to end. She kept us updated on progress at all times and advised us on options on how to proceed for the best resulting offer. Every step of the way was thoroughly explained to us and no stone was left unturned. Overall she was very meticulous and professional and we’ve been really impressed with her capacity of showing sympathy, compassion and genuine care when dealing with us on such a sensitive matter. It was very important for us to have someone lovely to deal with, someone with a big heart like Arti, considering the traumatic events we’ve been through.

Having had this going on for almost 16 months whilst battling with grief and continuing to fight infertility, it could have been really hard if not for Arti’s amazing support which led our case to an early admission of liability from the Defendant and a successful result in the end.

There are not enough words to describe how grateful both my husband and I are to Arti and the firm for all the help and support through the process."

Image credit: Soham Banerjee [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons