'We made a four-minute decision - six years later we were accused of the unthinkable'

From the moment Alta Fixsler's parents laid eyes on her, they knew she was special. She was the ultimate blessing.

The path to parenthood for Salford couple Abraham and Chaya Fixlser hadn't been straightforward. Their first child was born in 2013.

But after four years of trying for another, in 2017, Chaya suffered a devastating miscarriage. It meant that while the news she had fallen pregnant again in July 2018 was a source of immense joy, it was also tinged with anxiety.

READ MORE: Coroner pays tribute to family of tragic baby girl who died following high-profile legal battle

Then came a moment they had been dreading. Just 34 weeks into her pregnancy, Chaya began bleeding.

She was rushed into hospital, where doctors said she had suffered a placental abruption. They told her the baby had to be delivered by emergency caesarean section.

Confronted with this news, the couple spent a short period of time, four minutes to be exact, in discussion. Chaya agreed to the procedure.

Alta was delivered on December 23, 2018. Heartbreakingly, she had suffered a "devastating" brain injury.

Six years later, those four minutes would be pored over in agonising detail in a legal battle that drew worldwide attention. It would leave Abraham and Chaya feeling like they were being blamed for Alta's tragic death.

'Wrong, morally and legally''

Chaya was born in Jerusalem in 1989. She was poorly at birth as a result of a congenital heart defect. She underwent open heart surgery at age two and aged 18 had a mechanical valve fitted.

Abraham was also born in city, three years earlier. His parents separated and divorced when he was a child and he was brought up by his grandmother until the age of nine, when she died of cancer.

Afterwards he lived with his uncle in New York until, aged 19, he said he decided h wanted 'to build his own dream family to have a wife and kids and give them lots of love and care'.

Cheya and Abraham married happily in Israel and "shared dreams of being great parents". Their son was born in 2013 after an elective C-section.

Following her miscarriage in 2017, Chaya fell pregnant again in July 2018 and said the joy was "overwhelming." But given Chaya's condition and the tragedy a year earlier, the couple said they knew the pregnancy was "high-risk" and that they were "under constant stress."

On numerous occasions, Chaya she visited the hospital having suffered bleeds. But the family say they were reassured by doctors that everything was okay as long as the baby was growing.

On the morning of Sunday, December 23, 2018, just 34 weeks into her pregnancy Chaya suffered a severe bleed whilst at home alone in what was described as a "truly terrifying experience."

She rang her friend, a registered midwife, who then promptly phoned the local ambulance service Hatzola. Paramedics arrived within minutes after a conversation with St Mary's Hospital, where Chaya had received her antenatal care, she was transported there, with her husband arriving shortly afterwards.

At 10.37 am she was told Alta would need to be delivered by emergency C-section and that as she had taken her blood thinning medication that morning, it would have to be performed under general anaesthetic. She consented at 10.41 am and Alta was delivered at 10.54 am.

She had no heartbeat but was successfully resuscitated. However, she had suffered a severe brain injury as a result of hypoxia, the medical term for a lack of oxygen.

Yet Alta defied expectations when she began to recover her ability to breathe independently almost a week after her birth. She spent 14 months on the neonatal intensive care unit at St Mary's before being transferred to the paediatric ICU at the Royal Manchester Children's Hospital (RMCH) in February 2020.

However, she began to deteriorate. At 18 months old, Alta needed medical support to breathe once again, before requiring full mechanical ventilation weeks after her second birthday.

Chaya and Abraham said that although she was severely disabled and "unable to do practically anything on her own" she "lit up" their life with warmth".

"From the moment we laid eyes on Alta, we knew she was special" the couple said in a moving portrait penned for their daughter's inquest. Despite her medical condition, they described her presence was a beacon of hope and resilience.

“She taught us the depth of unconditional love and the true meaning of faith. Alta's strength and perseverance were evident daily as she endured numerous medical interventions and hospital stays with grace, inspiring everyone around her. We remained by Alta's side, advocating tirelessly for her care and planning for her to come home."

Tragically, these plans never came to fruition. Shortly before her second birthday, the Manchester University Foundation Trust which runs RMCH, applied to the High Court for life-sustaining treatment to be withdrawn as they believed there was "no prospect of recovery" and further treatment was not in her best interests.

The family said this went against their religious beliefs and said they wanted to move her to a hospital in Israel. The case made international headlines and saw interventions from politicians across the globe, including in Israel and the US where Abraham has citizenship.

The US State Department granted Alta a non-immigrant visa after cross-party campaigns.

But twice the UK courts found against the Fixler family, ruling the treatment was no longer in her interests, and it should withdrawn at a hospice rather than at home. She was transferred to Derian House Hospice where she died on October 18, 2021.

At Alta's inquest, Mr Golombeck recorded a narrative conclusion that she died as a result of a "combination of natural causes and the withdrawal of necessary mechanical ventilation."

He family said: "We envisioned a life where Alta would be surrounded by the love and comfort of her family, given every chance to thrive despite her severe disabilities... Alta's story touched many lives globally, with leading clinicians and hospitals offering support. Tragically, despite our tireless efforts and widespread support, Alta’s life was cut short. The hospital decided to seek court approval to withdraw her life support, a decision that devastated us. We felt betrayed by the healthcare system we had trusted.”

They added: "As Orthodox Jews, we believe in the sanctity and infinite value of all human life. We feel that Alta was taken from us unjustly because of her disabilities and that the decision to end her life was contrary to our values and beliefs.

“Despite our profound loss, we remain committed to sharing our story to advocate for better care and support for families in similar situations. Alta’s life, though brief, was a testament to resilience, love, and faith.

“She brought immeasurable joy into our lives and taught us the true meaning of strength and devotion. We remember our precious Alta for the light she brought into our world, and her legacy continues to inspire us and others touched by her story.”

Today, Abraham and Chaya say their overwhelming grief was compounded by the fact that her medical notes referred to an alleged four-minute "delay" in Chaya consenting to the C-section. At an inquest into her death, which concluded last week, a consultant said this "delay" contributed to the extent of Alta's brain injury.

Chaya's notes referenced the couple initially "refusing and declining" to proceed with the C-section, something the family always strongly disputed. They said they were simply clarifying if it was necessary for her to be put to sleep.

In evidence, Dr Sarah Vause, Chaya's consultant during her pregnancy, said the brain injury Alta suffered would have been less severe if Chaya had "agreed more readily" to the procedure and that "the delays caused by Mrs Fixsler contributed to Alta's profound hypoxia."

Area Coroner Zak Golombeck said the claim was "regrettable" and that the doctor had not had "due regard for the personal, familial, and cultural considerations the Fixslers understandably had".

He said it was "unlikely such enquiries would have been necessary had the clinicians at the time been unequivocal as to the emergency nature of the procedure" and that "once Mrs Fixsler understood the gravity of the situation she agreed to proceed."

The corner also highlighted the evidence of another of Alta's doctors, Professor Simon Mitchell, who said that had she been born four minutes earlier there "would not have been a significant change in her condition at birth".

He added: "To be clear, there was no delay in the sense that Dr Vause refers to, nor did any gap in time contribute to Alta's profound hypoxia. This is wrong medically and legally, and not something I would expect from a clinician of Dr Vause's seniority."

However, he added the care Chaya and Alta received was "reasonable" and "appropriate" at all times, and that the subsequent legal battle "does not take away the care and love Alta received from both parties" - adding that "there were no failures in the care afforded to Mrs Fixsler or Alta which more than minimally contributed to her death."

But following the inquest, the couple say they feel like they were being blamed for what happened to their daughter, and that claim has caused them "unbearable pain and distress".

A coroner dismissed any claim the four-minute delay contributed to Alta's death, describing it as "wrong, morally and legally". He added it was a tragedy that Alta's fate ultimately had to be decided in a courtroom.

Abraham and Chaya say they feel "vindicated". Following the inquest, they said: "Chaya is a doting, loving, and caring mother, and the blame placed upon her caused her unbearable pain and distress to us all.

"We are deeply grateful to the Coroner for taking our concerns seriously and feel relieved that he considers the blame attributed to Chaya to be both 'medically and legally wrong'. We are extremely alarmed about how [the Trust] handled our concerns, both during Chaya's pregnancy and after Alta's birth. Their words and actions were inconsiderate and unprofessional, causing us unnecessary heartache and stress.

"It is our firm belief that NHS clinicians should prioritise patient and family concerns ensuring that risks and emergency situations are fully explored and explained."

The couple described it as "inconceivable" that Chaya could be blamed for Alta's condition at birth, adding: "We feel profoundly let down... and have lost all faith in the NHS.

"We hope that Alta's inquest highlights the importance of clinicians prioritising patient and family concerns to ensure they are fully aware of risks and emergency situations.. Despite our profound loss, we remain committed to sharing our story to advocate for better care and support for families in similar situations."

Miss Toli Onon, joint chief medical officer for MFT said following the inquest hearing: "Today's inquest reminds us of the short but beloved life of Alta Fixsler, and also the heartbreak that her care and death brought to her family and everyone touched by her story. We offer our condolences and thoughts to Alta’s family, especially at this poignant and holy time of year for the Jewish community.

"It is clear from the evidence at this inquest that Alta's prognosis was never going to change and, sadly, that she could not live without life-sustaining support.

"The High Court and the Supreme Court recognised and accepted that prolonging life-sustaining treatment would be painful and not therapeutic for Alta; and that her clinical team and the Trust acted professionally, compassionately, and in her best interests at all times. Her clinical teams did everything they could for her, from the moment she was delivered and resuscitated at birth and then throughout her short life.

"We continually focus on improving the safety and quality of our patients' care, their experience, and that of their families. We will carefully review the coroner's findings and conclusions to identify any further learning opportunities and consider what additional steps are required.

"We hope the conclusion of this inquest brings Alta's family the comfort of knowing that everything possible was done for her during her life. May her memory be a blessing."