Posted: 06/09/2011
As the university year starts again, Philippa Luscombe, clinical negligence partner at Penningtons Solicitors LLP, urges people not only to be alert to the symptoms of meningitis but also to challenge doctors who say that they or their children are 'too well' to have meningitis.
Meningitis Research Foundation (MRF), the charity behind Meningitis Awareness Week (19-25 September 2011), continues its programme of public awareness of the signs and symptoms of meningitis. A main focus is the higher proportion of young people – particularly university students - who contract meningitis, particularly at this time of year.
While still a comparatively rare condition, the consequences of meningitis can be devastating if it is not correctly diagnosed and treated early. Viral meningitis is generally not life threatening but bacterial meningitis (which represents most UK cases) is very serious.
MRF statistics indicate approximately 3,300 cases of bacterial meningitis each year in the UK and one in ten people who contract meningitis do not survive. Of those who survive, approximately one in four are left with permanent disability. Quick diagnosis and correct treatment are vital for survival and a full recovery, hence the need for public awareness.
As specialist clinical negligence solicitors, we are frequently approached by people with concerns about delays in the diagnosis of meningitis – particularly in children. While we only see a snapshot of medical care across the country, our perception is that there has been an increase in the number of cases where the diagnosis has been missed or delayed and a common theme (particularly in children) is that the individual is said by the doctors to be 'too well' to have meningitis.
The difficulty is that the early signs - fever, vomiting and headache - can be hard to recognise and are often just typical symptoms of being 'unwell'. However, the key to a good outcome is to be open to the possibility of meningitis and to be ready to act if the symptoms progress. Other symptoms signs such as rash, joint pain, dislike of bright lights and a stiff neck are more specific and should never be ignored.
Increased public awareness of warning signs and symptoms is critical and patients, particularly parents, must feel confident of expressing their concerns about meningitis. If they are told by doctors that it is not likely, they must ask for a proper explanation and, crucially, for advice as to what signs should mean the need to urgently seek further medical advice. Meningitis can often be hard to detect early but patients who are sent away often delay in coming back for further advice, not appreciating the significance of further symptoms. We believe that medical professionals should focus on giving potential sufferers this guidance.
Delay costs lives and legal fees
The five recent Penningtons cases below all highlight the need for early and correct diagnosis:
Baby S - a newborn child with signs of infection was discharged without complete settling of his symptoms and without swab results. The infection progressed and he developed meningitis but, by the time he was readmitted to hospital, it was too late to prevent permanent and significant brain damage. He has very significant neurological deficits including almost total loss of hearing and vision.
Student N - a university student presenting with typical signs of meningitis and referred to hospital by NHS Direct was told she was 'too well' to have meningitis . Despite admission, blood tests were not processed quickly and she was not started on precautionary antibiotics. By the time blood test results were available and the severity of her condition appreciated, she had deteriorated to the state where she was unable to be saved despite emergency treatment.
Child I - a small child presenting with early signs of meningitis was assessed in hospital and discharged with diagnosis of urinary tract infection without any tests done or anti-biotics given. The delay in the correct diagnosis resulted in developmental delay.
Adult N - an adult patient presenting with early symptoms of meningitis was diagnosed with urinary tract infection and given oral anti-biotics and discharged . He was readmitted after deteriorating but suffered cerebral infarcts after only limited investigations and treatment. Patient left with significant permanent disabilities in mobility and communication.
Adult P - a GP's failure to suspect the possibility of spinal tuberculosis leading to tuberculosis meningitis and to refer for investigation and treatment resulted in significant permanent disability.
As clinical negligence lawyers who spend most of our time dealing with claimants with sad stories and see first hand the devastating effects of a delay in diagnosis of meningitis, we are keen to help highlight the importance of awareness of this condition and the need to act quickly where it may be developing.
From an economic perspective, the consequences of failing to make a prompt diagnosis are very costly. When individuals are left with serious and permanent disability due to a delay in diagnosis, the cost of the care that they need for life can be enormous – whether this is funded by the NHS or paid out as part of a claim. Better awareness by the public and increased consideration by medical professionals of the need to consider the risk of meningitis when assessing patients with signs that could be indicative will significantly reduce this outlay, thus releasing more funds for further research and treatment resources.
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