Archie Batten Inquest Conclusion – Death caused by Neglect

10th June 2022 – Archie Batten was born on Sunday 1 st September 2019, at the QEQM Hospital Margate, and lived for just 27 minutes. The Inquest into this death ended today in Maidstone with Her Majesty’s Assistant Coroner for North Kent Sonia Hayes concluding that his death was caused by neglect.

Adopting a narrative conclusion, and confirming that Article 2 applied to Archie’s death, Coroner Hayes, who heard evidence in the case over more than 2 weeks, found and concluded that:-            

  • The East Kent Trust did not have proper systems in place for home births while on divert at
    the time in breach of Article 2
  • Rachel should not have been sent home at 2:30pm. Nor should she have been told, at that
    point, that she could come back at any time, with a room kept for her, when the Maternity
    Unit was just about to go onto divert.
  • Instead the Trust eventually sent no fewer than 4 midwives to her home just 5 minutes
    away whilst all the while keeping the Maternity Unit on divert due to a lack of midwives.
    The first midwife arrived at the home at 5.00 pm
  • All 4 midwives failed to comply with the very basic requirements of midwifery, individually
    and cumulatively, over a 5 hour period from that first attendance until 10pm when Rachel
    and Archie were finally given an emergency transfer to the hospital.
  • There was a complete failure by the Trust / Midwifery Unit, on the one part, and the
    community midwives, on the other part, to communicate the fact that the Unit was taken
    off divert at 8:30pm at which point it is absolutely clear that Archie could and should have
    been transferred into hospital and delivered. Had this been done then he would have been
    born without complications or neurological injury.
  • Even when the midwives finally realised the urgency to the situation and arranged the
    emergency transfer there were further failings in communication whereby Rachel and
    Archie arrived in the hospital with neither the obstetricians nor the neonatologists having
    been properly alerted.
  • By the time Archie was eventually born at 10.42pm it was too late for him. The systemic
    failures of the Trust and the gross failings of the midwives, across the whole of the day, cost
    him his life. Had he been transferred to hospital he could have been saved and delivered
    without any neurological complications as late as 10.15pm.
  • Even after his birth, and during his resuscitation, the Trust’s record keeping was woeful with
    inaccurate records produced after the event retrospectively. It is still not clear today who
    the author of some of the entries was.
  • Archie was not still born, as the Trust and the midwives tried to argue, but lived with clear
    signs of life (heartbeats) up until 27 minutes of age. 
  • The midwifery failings were so fundamental as to amount to Neglect.

Nick Fairweather, the family’s solicitor, who represented them at the Inquest pro bono, together with barrister Richard Baker of 7 Bedford Row, commented:- “The family had to wait over 2 ½ years for the Inquest and are appalled at how they have been treated by the Trust and their legal representatives. This was exemplified by the Trust attempting to persuade the Coroner not to hear the case on the basis that Archie was still born waiting until just before the hearing before making that application. Whilst this application was given short shrift it added enormously to the family’s distress and anxiety and indeed their distrust of this Trust. Any renewed apologies for what happened cannot now be accepted. The systemic failings of the Trust have a depressingly familiar ring to them seen across our case load of QEQM cases It is important that the Coroner has recognised, however, that even when operating in a dysfunctional Department and in a sub optimal clinical setting it was still the professional responsibility of the individual midwives to provide a due and proper level of care to Archie and Rachel. This they manifestly failed to do.”

Speaking following the conclusion in a statement released through their solicitors parents Rachel and Andrew said:- “Listening to all the evidence in the case has been hard. It seems incredible to us that so many basic mistakes were made by so many people on the day of Archie’s birth and death. We do feel, however, that we have got justice for Archie today and thank the Coroner for her expertise and the thoroughness of her investigation. We also thank our legal team, who representing us free of charge at the Inquest, without which we would not, on our own, have been able to stand up to the Trust’s expensive lawyers and ensure that Archie’s case was properly considered. Archie would be 2 ½ years old now. We think about him and miss him every day and always will. Nothing can bring him back to us. We can only hope that true lessons will be learned from his case and lasting changes made to ensure that other families do not suffer such tragedies in the future”

If you or your family need the assistance of an experienced team of Clinical Negligence Solicitors surrounding an inquest or civil claim then please do not hesitate to phone us free on 0800 999 5585, request a call back or submit your case details.