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The tragic death of a new mum who went missing for seven hours in hospital after giving birth will not be probed as a fatal accident inquiry, it has been announced.
Amanda Cox is thought to have collapsed in a stairwell at Edinburgh Royal Infirmary while searching for painkillers days after the premature birth of son Murray.
The 34-year-old, who had suffered severe headaches before being admitted to the maternity ward, turned into a disused part of the facility not covered by cameras in December 2018, Edinburgh Live reports.
The new mum, who had been reported missing, was found dead wearing just pyjamas and slippers after suffering a fatal brain haemorrhage.
In a statement, NHS Lothian said the decision had been taken following discussions with Amanda’s family and the outcome of an internal ‘serious adverse event review’ and separate probe by the Scottish Fatalities Investigation Unit.
The health board said efforts had been made to prevent a repeat of the incident but Amanda's widower Michael said the measures came “three years too late.”
In a statement issued by Thompson’s solicitors, he added: “Had these basic, common-sense measures been in place then Amanda would not have lost her life in the tragic circumstances she did.
“Amanda was a beautiful, caring person and a wonderful wife. She had just become a mother to our son. She did not deserve such a catalogue of errors in her care from NHS Lothian.”
NHS Lothian said Amanda was "believed to have become disorientated when she left the neonatal unit to make her way back to her ward".
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The health board added the "the management of headache in pregnancy and women with complex obstetric care needs" had been subjected to a clinical review, while "a robust action plan was put in place to improve maternity patient pathways and upgrade signage and wayfinding."
Medical director Dr Tracey Gillies said: "NHS Lothian conducted a thorough investigation to help prevent a similar tragedy happening again.
"The recommendations about the physical area were implemented immediately and clinical recommendations have also been shared with obstetric and neurology services across Scotland to help develop national guidance.
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"The death of Mrs Cox was a deeply tragic occurrence and our sincere condolences remain with her family. We are so sorry that she died in our care."
Katrina Parkes, head of the Scottish fatalities investigation unit of crown office, said: “The decision not to hold a Fatal Accident Inquiry has been taken in consultation with Amanda Cox’s family, who have suffered a terrible loss, and I would like to thank them for their patience and co-operation.
“NHS Lothian have provided assurance that significant changes have been made since Amanda’s death and I sincerely hope the lessons learned will help prevent similar deaths in the future.”
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