At the end of three days of complicated medical evidence looking at the death of little Jorgie Stanton-Watts, Zena Stanton was finally given the chance to address the people who said she holds responsible for her grandaughter's death.
Taking the stand, physically supported by her husband Bob. who kept his hand on her shoulder as she wept during her evidence, 68-year-old Zena spoke of how the loss of Jorgie, who died after she was neglected at Kettering General Hospital, had affected her ‘strong, united family’.
Her statement to the court was the final word on what had been a painful three days at the Coroner’s Court in Northampton and the family, that had remained composed through the entire proceedings, sobbed as they listened to her poignant words.
Jorgie, from Corby, was just 23-months when she died after a series of five failures on Skylark Ward in October 2016.
Reading a family impact statement at the final day of the inquest into her death yesterday (April 3, 2019), Zena said: “Now it is us, Jorgie’s family's chance to say how we feel about what happened - how we have lived through a nightmare that will not go away.
“How the way the police conducted their investigation and made decisions without gathering what we thought were all the relevant statements.”
Key medical staff were not interviewed for eighteen months following Jorgie’s death.
“We put Jorgie into the hands of the people we trusted and one of our biggest fears now is if one of the other kids becomes unwell. Who do we trust?
“We feel throughout these investigations, one thing has been forgotten - our beautiful little sunshine died, and we watched her failing and no one was listening or acting on the clear visible signs of her failing.
“We are a strong, united family and what hurts one of us hurts us all.”
Zena, who was with Jorgie on the day she collapsed, told how she brought ‘such joy’ to the family and quickly became the focus of all their lives and earned the nickname ‘Sunshine’.
She went on: “We are hoping by listening to us today and seeing our pain that this will have a bigger impact than any action plan that has been drawn up will do."
"An action plan that we were told would have had involvement in. An action plan that we received and were just asked what we thought of it.
"When I contacted (KGH Medical Director) Andrew Chilton to say the biggest problem of Jorgie's admission had not been mentioned or addressed: that family concerns had not been listened to, he informed me they were looking into how a patient could have a voice.
"Well Jorgie did have a voice, a loud clear voice. Us. But we were ignored time and time again until we had to go above the staff on the ward to get action from someone we knew would listen and act. But by then we now know it was too late."
Zena went on to describe the effect of Jorgie's death on her sister Charliegh, now six. She said: "When we explained to her Jorgie was now the brightest star in the sky, and that's where she was living now, we thought she understood.
"But then it was her birthday and she was so excited at having a party. When we got to the venue she went running in so excited running round and round the room. Then she was screaming hysterically 'Jorgie where are you?'
"No, she didn't understand why her little sister wouldn't come back for her."
She described the effect on Billy, 15, Jorgie's brother.
"When he came in from school Jorgie's arms would go up and she would kick her legs about for him to pick her up. He would take them both upstairs into the sensory room. No gentle relaxing music in there before bed. No, it was loud Rod Stewart, Meat Loaf and Fine Young Cannibals.
"Now Billy is such a changed boy."
Zena told the court how he is 'angry all the time.'
She said the home of Jorgie's parents, her daighter Nicola Stanton, 44, and Stephen Watts, 43, was always 'full of laughter' and that their lives revolved around the kids.
"Now it is so different," said Zena.
"They rarely go out. The laughter has gone. She has been so depressed and is unable to work. Stephen is so full of anger about how Jorgie died. He cannot come to terms with it."
Jorgie died in the arms of her dad, Stephen, on October 8 after doctors said there was nothing more they could do for her.
Nicola's sister Sally had been on the verge of giving up her job to help Nicola care for Jorgie just before she died. Her cousin Ollie 'cannot understand why Jorgie is not coming back.'
Talking about herself and her husband Bob. Zena said: "We so much looked forward and planned for our retirement. Instead we mourn the loss of Jorgie.
"For the first time in my life I'm on anti-depressants and have been diagnosed with post-traumatic stress disorder and so depressed some days I just can't function. I relive her final days on Skylark ward over and over again. I can see and hear her and how distressed she was and ask myself why did I put so much trust in them?"
She said that after Billy had seen the family coming and going in police cars, he asked 'did they murder my sister?'
"Our answer right away was 'of course they didn't.'
"But I think now if 15-year-old Billy had asked me the same question we would give a different answer.
"No, they didn't deliberately murder our beautiful, beautiful little sunshine but if they had listened to us she would not have died. That is what we live with day after day."
Following the conclusion of the inquest, Nicola Stanton said that the family was pleased that the coroner had recorded a neglect verdict.
But she added: "This is what we wanted but there are no consequences for the medical staff who failed. I won't give up here. I'll continue to fight for Jorgie.
"We've had several other families in similar situations contact us already. We want to speak to them about their experiences."
Just two months after the death Nicola and her family launched Jorgie's Buddies, an organisation set up to fund personalised bears for very sick children in and around Corby. Since December 2016, they have handed out 265 of the bears. You can find out more about the charity here
Following the inquest, Kettering General Hospital apologised to Jorgie's family for their failures. You can read the full verdict and their statement on our website here.