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Tuesday, 30 September 2014

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Cumbrian hospital failed our mum, say grieving children

The grieving children of a woman whose death prompted an investigation into her hospital care say the medics she put her faith in failed their mum.

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The family of Dorothy Ross said they were devastated to lose their “fit, active and independent” mother.

They added there “seemed to be no consequences” for hospital staff behind errors at the West Cumberland Hospital in Whitehaven, where the retired dinner lady lost her life.

Bosses at the trust running the hospital have already issued a statement saying they had “taken appropriate steps to prevent any such incidents happening again in the future”.

Now, in a statement issued exclusively to the News & Star, son Ian Ross, of Seaton, Workington and daughter Gillian Mudie, of Frizington, said: “When mam went into hospital we assumed she was in a safe place. Our faith and confidence in the health service has been shattered by what we now know.”

A coroner ruled Mrs Ross, 75, of Cleator Moor Road, Whitehaven, could have lived if the right treatment had been given.

An inquest heard she might have survived if a blood sample had been taken when it was supposed to be, with medics likely to have spotted the effects of a drug she’d been given to stop blood clotting.

David Roberts, north and west Cumbria coroner, said she died “of the consequences of” a blow to the head in a fall at home – but added a bleed on the brain was “exacerbated” by the treatment adopted before surgery.

A report in the wake of her death highlighted numerous failings by the hospital. In their statement, Mr Ross, 46, and Ms Mudie, 42, said: “There were a number of opportunities to save her but all were missed.

“Our mam was a staunch supporter of the West Cumberland Hospital but the people she put her faith in failed her. We don’t want to see the hospital closed but our community should be able to rely on a safe health service.”

The inquest at Cockermouth was told Mrs Ross slipped on a plastic bag at home on April 17 last year.

She was admitted to the hospital and found to have fractured her hip and wrist. Mr Roberts said she also banged her head.

Mrs Ross was taking Warfarin as an anticoagulant – to help prevent the formation of blood clots – and the effects of this had to be reversed before surgery, with the pensioner set to have pins put in.

The plan was to administer vitamin K followed by the drug Heparin, a different anticoagulant, and to check for the level of this drug in her blood after six hours. But Mr Roberts said: “Failure to clearly document the plan resulted in premature administration of Heparin.”

Blood for testing should have been taken at 10.30pm on the day she went into hospital but was not taken until 1.30am the next morning. Despite being marked urgent, the sample was processed routinely and a call was not made to the lab stating the urgency. The lab then failed to notify the ward that no analysis had been possible until 7.45am.

A nurse rang for the result at about 9.30am and “the result was off scale”, the inquest heard. The nurse stopped the Heparin infusion but at 9.35am staff could not rouse Mrs Ross and she went into respiratory arrest. She had developed a subdural haematoma, where blood collects between the skull and the brain, and died just after 2pm on April 18.

The family’s solicitor, Lynne Hall, from Cumbrian law firm Burnetts, said: “They can only hope that what comes out of their mam’s death is that no future deaths will occur in light of the new regime.”

Dr Jeremy Rushmer, medical director at the North Cumbria University Hospitals Trust, which runs the West Cumberland Hospital, said; “We have carried out our own immediate investigation to ensure we fully embed the important safety learning among all of our teams and across both of our hospital sites.

"While we recognise this does not change the very sad outcome for Mrs Ross and her family, we hope it provides the necessary assurance that we have taken this case extremely seriously and taken appropriate steps to prevent any such incidents happening again in the future.”

The family thanked their legal team and Mr Roberts.

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