The Coroner gave his verdicts today at the conclusion of the conjoined Inquests into the deaths of two mothers who died in December 2007 within 24 hours of each other at the Royal Hampshire County Hospital in Winchester.
Verdicts of natural causes were given in both cases.
Amy Kimmance, 39, gave birth to her third child, Tessa, at the hospital on 21st December 2007. She was readmitted to the hospital the next morning in very severe pain. During the course of that day her condition deteriorated and she was admitted to ITU. She died the next afternoon, 23rd December having suffered multiple organ failure due to Group A streptococcus septicaemia.
Jasmine Pickett, 29, gave birth to her first child, Christopher, at the hospital only a matter of minutes before Amy on 21st December 2007. Having been discharged home from the hospital in the late afternoon of 23rd December, her condition deteriorated on the following morning and she died shortly after her emergency readmission to the hospital via ambulance early on Christmas Eve. By the time of her death Jasmine had developed sepsis due to the same bacteria and Group A streptococcus pneumonia.
Following the Verdict Amy’s husband, John Kimmance, said:
“I now have a better understanding of what happened to Amy which will help me to explain to my three children how and why Amy died when they ask – as they do and as they will continue to do. It is clear from the evidence that was given that we will never know how it was that Amy came to be infected with Group A Strep, but having heard that there was a raised level in the community at that time, I have some sense of closure on that issue.
I am very pleased to hear that the Royal Hampshire Hospital now routinely uses the early warning scoring system (MEOWS) for monitoring all women who are admitted to the Maternity Unit and that it has also introduced guidelines for the assessment of all women who are readmitted – the latter we heard is unique. Nothing will change what has happened to our family, but it would give me some reassurance that this tragedy won’t happen to another family if this approach was to be adopted not just in Winchester, but across the Country.
Finally, I would like to take this opportunity to express my gratitude to all those medical and nursing staff who were involved in trying to save Amy’s life after her collapse.”
David Pickett said:
“I am preparing myself for answering Christopher’s questions about how and why Jasmine died. I now have more information and I can tell Christopher that it was not his fault.
During the Inquest we heard what changes the Hospital have made to their procedures. I sincerely hope that these will prevent this happening to anyone else. I would ask the Royal Hampshire Hospital and Hospitals across the UK to consider providing new parents with a leaflet on discharge home warning them about the risks of infection and telling them what signs and symptoms to look out for in order to lower the threshold for seeking hospital or medical advice.
Finally, I would like to use this opportunity to thank the Ambulance staff who came so quickly when I called them when Jasmine collapsed in our home and who tried to save her and also to the staff in the accident and emergency department to where she was taken.”
Claire Fazan of Leigh Day and Co, solicitor for both husbands, said:
“We now know more about what happened in the days prior to Jasmine’s and Amy’s deaths. We have heard very reassuring evidence to the effect that investigations carried out at the hospital indicated no apparent failures in infection control. It appears that we will never know what the source of this cluster of infections was. We have also heard evidence that indicates that opportunities to diagnose and treat both women at an earlier stage were or may have been lost.
Shortly before the sad events that have been the subject of this Inquest occurred, the last report of the Confidential Enquiry into Maternal and Child Health (CEMACH) was published. In the conclusion to the chapter on Sepsis, the authors of the Report said that the fear and respect with which puerperal sepsis was held in the past by obstetricians, midwives and patients has disappeared from our collective memory and that action is now required to raise awareness of the signs and symptoms of sepsis and its recognition. Let us hope that the tragedy that has befallen these two families and the publicity that this has generated will assist in educating all of us and most especially doctors, midwives and new parents.
For more information please contact
Claire Fazan at Leigh Day & Co on 020 7650 1200.
Information was correct at time of publishing. See terms and conditions for further details.