Tragic hospital deaths of mother and baby could not be prevented - coroner

A coroner has ruled the tragic deaths of a mother and baby, who died just minutes apart, could not be prevented.

Harrison Earnshaw was born via emergency C-section after his mother, 29-year-old Samantha Whyman, had suffered a heart attack. He lived for just over 30 minutes.

The findings of a coronial inquiry, which concluded their deaths were "not preventable at the material time", can now be shared.

Whyman was 29 weeks pregnant when she was rushed to the Emergency Department at Palmerston North Hospital by ambulance in 2024.

She was described as a "much-loved mother, daughter, daughter-in-law, partner and sister".

On April 13, 2024, Whyman was feeling unwell with chest pain, fever, and shivering an hour after her GP drained a cyst from her armpit.

When she arrived at the ED in an ambulance, she was suffering from a headache, a high temperature and "severe" chest pain.

A series of tests was performed, and Whyman was found to have an elevated troponin level. There was a delay in communicating this information to clinicians, and a repeat troponin level was requested.

As clinicians discussed her case and her results to formulate a treatment plan, the emergency bell was activated.

She had been found in a collapsed state, and resuscitation commenced "immediately".

During this time, her baby, Harrison, was delivered by emergency C-section, and resuscitation on him also started.

After he was intubated, doctors noted a heartbeat, but his body was not making an effort to breathe.

Medical staff concluded he had been hypoxic for a "long period of time", with a lack of oxygen likely causing brain damage before he was born. Blood gas results confirmed this.

Tragically, it was assessed that Harrison could not survive, and senior clinicians agreed that continuing aggressive treatment would be "futile".

Attempts to resuscitate the baby stopped, and his death was confirmed at 3.48pm. He was alive for just 38 minutes.

Despite "extensive efforts" and the use of "all available life-preserving measures", Whyman could not be revived either. She died at 4.15pm, just 27 minutes after her son.

Following a post-mortem, her primary cause of death was determined to be acute myocardial infarction (heart attack) due to atherosclerotic cardiovascular disease, which is caused by plaque build-up in arterial walls.

An auxillary abscess was found not to have contributed to Whyman's death.

Both findings were accepted by the Coroner.

Harrison was not examined after he died, and his cause of death was determined to be perinatal asphyxia.

During the inquiry, chief medical adviser to the Coroner's Court, Dr Garry Clearwater, gave the opinion that Whyman "would have died in any event, even in a best-case scenario".

"This is because the primary cause of death was extensive coronary artery disease and myocardial injury. This could not have been definitively treated on site with angioplasty and bleak or urgent open-heart surgery," he said in a report. "Those services are unavailable at Palmerston North Hospital."

He also said Whyman's pregnancy was a "major complicating factor" as the treatment for arterial thrombosis increases the risk of bleeding related to pregnancy or surgery.

"Even if Ms Whyman had survived her cardiac arrest, transfer to a regional hospital would have involved inevitable delays while the patient’s condition was stabilised (if that were possible), including management of the pregnancy."

Coroner Ian Telford wrote in his findings: "It seems that the medical evidence overwhelmingly supports a position that by the time Samantha attended ED she had extraordinarily advanced, widespread and chronic coronary artery disease."

He said there was also evidence she had previously suffered a silent heart attack.

"It is therefore proposed that the likelihood of her ultimate death, although not inevitable, was high notwithstanding the care provided to her at that point in time."

The coroner said Harrison's premature birth would have likely led to a similar outcome.

It was ruled that Whyman and Harrison's deaths were "not preventable at the material time".

Regarding their care in the emergency department, Telford referred the case to the Health and Disability Commissioner to see if services were provided safely and in line with the patients' rights.

In his final comments, the coroner said it had been an "extremely sad case", praising Whyman and Harrison's family as "splendid" advocates.

Following Whyman and Harrison's deaths, a Givealittle page was set up to support the family.

A message on the page read: "Samantha was the most selfless, beautiful, loyal and caring sister, daughter, aunty, partner, friend and soon-to-be mother.

"She also had the most inappropriate, unfiltered, hilarious sense of humour, and continuously made us all laugh, alongside her own cackle."

It said her younger brother, Justin, had passed away less than a year before, also at 29.

An obituary posted to the Manawatū Standard said Harrison was a "lovingly longed-for addition to the family and was loved so much by his Mum Sam and Dad Michael.

"They will be dearly missed."

Over 100 people donated to the page, with a total of $10,260 raised before it was closed.

"You will never know what this means to us to help get us through this trying time with the loss of our two beautiful children and grandson in such a short period of time," the page read.