Dad’s death on day of baby’s birth ‘was preventable’

Dr Bull said the ECG scan was likely to represent an abnormality he described as an intraventricular block, which is “not an uncommon finding” and not clinically “significant” without other heart-related symptoms.

As there were no other heart-related symptoms he was discharged.

But later analysis concluded the ECG identified a complete heart block, also known as a third-degree heart block, the most serious kind.

Dr Matthew Thornber, a consultant at the hospital, said the two ECGs taken were not “textbook” examples of looking like a heart block condition and such diagnosis requires nuance and experience.

“This is not a barn door easy miss,” he said.

The coroner said he would be writing a prevention of future deaths report, addressed to the chief executive of the Manchester University NHS Foundation Trust and the National Institute of Clinical Excellence concerning clinical practice, around the interpretation of ECG scans.

In a statement, Manchester University NHS Foundation Trust said: “We wish again to extend our condolences and sincere sympathies to Mr Gibson’s family at this very difficult time.

“The trust has undertaken a thorough investigation to examine the circumstances following Mr Gibson’s very sad death, and we apologise for where our care has fallen short of the high standards to which we aspire.

“We will be reviewing the coroner’s conclusion carefully.”