Russell's Hall Hospital: Trust fined £2.5m over deaths

Natalie Billingham and Kaysie-Jane Robinson died at Russell's Hall Hospital in 2018

A hospital trust has been fined £2.5m over the death of two patients.

Natalie Billingham and Kaysie-Jane Robinson, who had sepsis, died in 2018 at Russell's Hall Hospital.

At Wolverhampton Magistrates' Court, Dudley Group NHS Foundation Trust, which runs the hospital, was also ordered to pay a £38,000 contribution costs to the Care Quality Commission (CQC), which brought the prosecution.

The trust offered its "sincere condolences" to the families.

Kaysie-Jane's mother, Jane Robinson, said both families felt staff could have done a lot more.

"No matter whatever fine, whatever the cost, the money, the amount, it is not going to bring Kaysie-Jane or Natalie back," she said.

On Thursday, the first day of a two-day sentencing hearing, the court was told concerns about sepsis management at the trust were raised by inspectors months before the deaths.

The trust pleaded guilty at a previous hearing to safety failings.

Passing sentence, District Judge Graham Wilkinson said the failings in care received by both Ms Billingham, 33, and 14-year-old Ms Robinson were "reflective of an organisation that had been in crisis".

He said the deaths occurred after the trust "failed to act swiftly and decisively" to concerns raised by the CQC inspectors.

Conceding that improvements in care had been made since the "dark days" of 2018, he said one of the offences had caused the death of Ms Robinson.

He told the court: "Every patient that attends [an emergency department] has a right to expect that the care they receive will be safe."

Mrs Robinson said her daughter was the "bravest, most robust little girl I have ever met" and it was "just heartbreaking" to know she could still have been alive with the right treatment.

The watchdog said the two people were exposed to "significant risk of avoidable harm" at Russell's Hall Hospital

The judge said the trust had been identified as one of 10 trusts with high levels of mortality in the wake of the Mid-Staffordshire Inquiry, which led it to be included in Sir Bruce Keogh's national programme.

In July 2013 that reported on 14 trusts and recommended a number of changes.

"It is just another tragic aspect of this case that those recommendations had not led to any sustained change at the time that Natalie and Kaysie-Jane entered the emergency department," the judge added.

The hospital trust has previously accepted Ms Billingham and Ms Robinson were exposed to "significant risk of avoidable harm" and in July admitted two breaches of the 2008 Health and Social Care Act.

Following sentencing, its chief executive Diane Wake, said: "We are deeply sorry that our care did not meet the standards Kaysie-Jane, Natalie and their families had a right to expect.

"Although it will offer the families little comfort, we have learned from the failings that led to Kaysie-Jane and Natalie's tragic deaths and made fundamental changes in the way our care is provided."

• Latest news from the West Midlands

Ms Billingham was admitted to Dudley's Russell's Hall Hospital with numbness in her right foot on 28 February 2018 and died on 2 March of organ failure caused by a "time critical" infection.

The court heard she was initially thought to have a deep vein thrombosis after a brief triage that failed to identify "disordered" observations, with opportunities to reconsider that diagnosis "missed or ignored".

Ms Robinson, who had cerebral palsy and was initially believed to have gastroenteritis, was given an inaccurate "early warning score" meaning a sepsis screening tool was not triggered.

She died six days later after being transferred to another hospital.