Nottingham University Hospitals (NUH) NHS Trust has received a £1.6 million fine following the deaths of three babies in 2021. The penalty, imposed by Nottingham Magistrates’ Court, comes after the trust admitted to six counts of failing to provide safe care and treatment to both the infants and their mothers.
The Cases
The deaths occurred within a 14-week period in 2021:
- Adele O’Sullivan – died 26 minutes after birth on April 7
- Kahlani Rawson – died at four days old on June 15
- Quinn Parker – died at two days old on July 16
Clinical Failures Identified
The court identified several critical failures across the cases, including:
- Inadequate staff training in cardiotocography (CTG) interpretation
- Delayed recognition of serious conditions
- Substandard handover processes
- Failure to expedite emergency deliveries
- Poor monitoring of placental abruption cases
Case Details
Quinn Parker
- Mother Emmie Studencki visited hospital four times with bleeding
- During final visit, she experienced major antepartum hemorrhage
- Paramedics recorded 1,200ml blood loss
- Critical information failed to reach hospital records
- Emergency caesarean section revealed baby “pale and floppy”
Adele O’Sullivan
- Mother experienced bleeding and abdominal pain
- No vaginal examination performed
- Delays in labor identification
- Born prematurely via emergency caesarean
- Inquest revealed “missed opportunities” in maternal care
Kahlani Rawson
- Mother reported reduced fetal movement
- Poor monitoring “from the outset”
- Critical information not communicated to consultants
- 20-minute delay in emergency caesarean delivery
- Coroner confirmed “failings in care”
Legal Proceedings
The fine represents:
- Largest ever penalty for NHS maternity care
- Reduced from £5.5m considering trust’s finances
- Additional £67,755.23 in prosecution costs
- £190 surcharge imposed
Trust Response
Anthony May, NUH Chief Executive, stated:
- Acknowledged failures in care
- Apologized to affected families
- Recognized impact on staff
- Committed to service improvements
Regulatory Overview
The Care Quality Commission (CQC) confirmed:
- Second prosecution of this trust
- Previous £800,000 fine in 2023
- Continued monitoring of improvements
- Focus on safe care implementation
Current Status
The trust is currently:
- Under largest NHS maternity review to date
- Examining approximately 2,500 cases
- Operating with £100m deficit
- Implementing safety improvements
This case represents a significant development in NHS accountability for maternity care standards and highlights ongoing challenges in healthcare safety governance.
