Kayleigh Garrington of Darlaston in the West Midlands gave birth to a healthy son, Terence-Jeffery (TJ) Smith at Walsall Manor Hospital in Walsall, near Birmingham, in the early hours of 11 August 2008 following an uncomplicated pregnancy.
Initially, Terence seemed to be well and in good condition and mother and baby were transferred to the postnatal ward. Over the course of the rest of that night and the day, observations of Terence indicated a temperature at the high end of normal and, later, a raised respiratory rate. By the afternoon he had been noted to be occasionally ‘jittery’ and pale.
Those monitoring Terence were sufficiently concerned to call on a paediatrician to review him. He was seen that afternoon and it was noted that he still had a respiratory rate above normal, was pale, was ‘head bobbing’ and ‘irritable’. The plan was for him to remain on the maternity ward overnight and to be reviewed in the morning. Observations continued and later that day he still had a raised respiratory rate and was noted to be unsettled.
On 12 August at 02.30 Terence was again described as being very unsettled and ‘twitchy’ with a raised respiratory rate. The paediatric SHO was bleeped to attend but did not do so and the nursing team called for the paediatric registrar to attend, which he did at 03.40.
He concluded that Terence did not appear septic and his unsettled behaviour could possibly be due to pain associated with reflux of milk from the stomach into the gullet. The plan was to administer a single dose of paracetamol, to feed him three-hourly, to monitor his temperature and oxygen saturations four-hourly and for the paediatrician to be informed if there were concerns.
The nursing staff did not carry out four hourly observations as directed but did note at 8-9am that morning that Terence’s respiratory rate remained raised, he had a slightly high-pitched cry and his hands were clenched. At times he had tremors when disturbed. Later that morning he was reviewed by a paediatric senior house officer as he was unsettled and irritable with a raised respiratory rate. It was noted that he had a slight yellow discharge from his left eye, was jittery on tactile stimulation and was crying. His cry was again described as ‘high-pitched’.
The SHO concluded that Terence did not appear septic or in distress but, in view of the irritability, queried whether he might be showing signs of drug withdrawal syndrome. It was noted that Miss Garrington smoked 20-30 cigarettes daily. The situation was discussed with the paediatric registrar who indicated that he would review Terence and did so shortly afterwards. The plan was for Terence to stay in hospital overnight and be observed ‘as per protocol’. The possibility of nicotine withdrawal or other substance withdrawal was raised.
Despite the direction for regular observations, these were not done until 12.30 the following day, 13 August. Terence was noted then to have a raised temperature, to be hypertonic and to have tremors. The paediatric SHO reviewed him and the plan was to keep him in hospital overnight and, if he remained settled, he could be discharged in the morning. Later that afternoon, eye swabs were taken due to the discharge and sent for non-urgent analysis.
The following day, 14 August, Terence appeared more settled and continued to breast feed well with normal temperature and respiratory rate but still with tremors. Plans were made for his discharge and Miss Garrington was advised to seek medical help if the eye discharge became worse or he became unsettled. Two days later, 16 August, Terence collapsed at home and was rushed back to Walsall Manor Hospital A&E. Sepsis was immediately suspected and tests confirmed bacterial meningitis. That same day the eye swab results confirmed the presence of bacterial infection. Despite treatment being started, Terence suffered a number of seizures. Subsequent testing and assessment confirmed the presence of extensive brain damage resulting in severe damage to his vision and hearing and later to his muscle, mobility and other development. Terence was very severely disabled and remained totally dependent on his parents for high level care. In March 2011 he developed a serious infection which he was sadly unable to fight. He died on 3 March aged two years and seven months.
Miss Garrington was concerned that the hospital had been sufficiently worried to keep Terence in for observation but had not carried out any tests. She had felt and had reported to the staff that she was concerned about Terence as he was not acting as her other babies had done. She got the impression that the focus was very much on nicotine withdrawal and nothing else.
She instructed Philippa Luscombe of the clinical negligence team at Penningtons Manches to investigate whether the hospital had properly cared for and assessed Terence. Expert evidence was obtained from a paediatrician and a microbiologist which concluded that, given Terence’s documented condition, the possibility of sepsis should have been considered and investigated on both 12 and 13 August 2008.
It was the experts’ view that investigations carried out on either day would have confirmed the presence of developing sepsis from bacteria (which had colonised initially in the eye and was spreading through his bloodstream); that antibiotics would then have been started; and that antibiotics commenced on either day would have avoided the sepsis progressing to bacterial meningitis at all thus avoiding the brain damage in its entirety. It was the view of our experts and the coroner that Terence would have survived the infection in March 2011 if he had not been so severely compromised by his brain damage and disability.
A claim was presented to the Walsall Healthcare NHS Trust on this basis. It denied any failings in Terence’s care and so court proceedings were issued. Throughout the case, the trust maintained that there was no reason to suspect or investigate sepsis. However, as the evidence evolved, it appeared that it accepted that, had the signs been at a level consistent with sepsis (which they disputed), investigations would have revealed the presence of sepsis. With provision of antibiotics, the meningitis and, in turn, the brain damage and, ultimately, Terence’s death would have been avoided.
Despite this and despite serving only one witness statement from the paediatric registrar in support of its case, the trust continued to argue that investigation and management for potential sepsis was not mandated.
Offers of settlement by the claimant and suggestions of alternative dispute resolution were not responded to and so the matter proceeded to within a couple of weeks of a high court trial. At that stage, the trust suddenly entered into negotiations and the case was settled on the basis of a figure which would have reflected success in the case at trial.
Commenting on the case, Miss Garrington said: “I always felt that something was wrong with Terence while he was in hospital but felt that my concerns about him were dismissed and that the staff simply focused on the fact that I was a smoker and this was the reason for Terence’s symptoms.
“To have him collapse at home and to be so seriously ill, having been reassured that he was OK was the most traumatic experience for us as parents. Terence was very much loved by his family but had a very limited life, both in quality and length. The experts in our case were very firm that Terence should have been investigated, given what was recorded in the notes, and that, with proper care, he would never have suffered the meningitis and would have had a normal life. He and our family lost that opportunity because he was not properly assessed and the medical staff did not recognise that he might have sepsis.
“I brought this case because I felt that Terence had been let down and I want to draw attention to it now because I have been so disappointed that the trust has never acknowledged that they got it wrong for Terence.
“It took us to the brink of a High Court trial for the trust to enter negotiations and settle the claim. This claim was always about making the hospital recognise and acknowledge its errors – in the hope that the same would not happen again. From the way in which the case has been dealt with, I worry that lessons have not been learned and this is why I want to draw attention to Terence’s case. If the trust had acknowledged its failings far earlier, then the money that has been spent on fighting a case all the way to trial could have been better used to educate medical staff so this doesn’t happen again.
“I hope that by drawing attention to the case, I can help other mothers to know what to be concerned about and make the hospital think about how it cares for babies who are unwell."
Philippa Luscombe, the solicitor who dealt with the case at Penningtons Manches comments: “I had the pleasure of meeting Terence before his untimely death and he was a very loved little boy. It is a tragedy that he never got the chance to enjoy a normal life. Kayleigh has only ever wanted the hospital to acknowledge that it did not provide good enough care to Terence and that the lessons have been learned.
“Sadly, that has not happened and the trust has defended this case all the way, only to concede and settle the case at the last minute – the most costly way to deal with litigation against the NHS.”
To view coverage of this case in the Walsall Advertiser, please click here.