The clinical negligence team at Penningtons Manches LLP has recently settled a liability agreement in a claim brought on behalf of a child against Watford General Hospital. The case related to an alleged negligent delay in diagnosis of meningococcal septicaemia, which led to a lower limb amputation.
The claimant, aged 20 months at the time of the incident, developed signs of an upper respiratory tract infection with a raised temperature and was generally unwell. His mother took him to the GP where he was noted to be pyrexial and cold. Two days later his mother felt that he was still really unwell and took him back to the GP practice. She was specifically concerned by his high temperature of over 39 degrees, the fact that he was not responding to medication and that he seemed very unsettled. The GP noted that the child’s fever, runny nose, cough, a sticky eye and lack of appetite had lasted for eight days. His temperature was high even after taking paracetamol and he had a raised respiratory and heart rate. The GP also noted a blanching rash on the trunk and cold peripheries.
The GP telephoned the paediatric team at Watford General Hospital to advise that she was referring him to them. The claimant’s mother took him straight to A&E where he was triaged by the children’s emergency unit. A medical history was noted, including him being unwell for eight days with a temperature, decreased drinking, one episode of vomiting, cold hands and feet, mottling on the feet, being very sleepy and having blanching spots on the chest and a sticky eye. He still had a high temperature, pulse and respiratory rate. While the triage nurse was concerned about his condition and flagged this with the paediatric medical team on duty, she failed to properly categorise the claimant in terms of early warning score. Because she scored him too low, the requirement for consultant review and other management was not triggered as it should have been.
There was then some delay before the claimant was seen by a doctor – he was eventually seen by a senior house officer (SHO). It was alleged that the SHO’s assessment was inadequate and she failed to take heed of signs that could have been due to developing sepsis. She reported an unconcerning picture back to the registrar and a decision was made to arrange a chest X-ray and repeat observations after antipyretics. The claimant was not seen by anyone more senior for several hours.
A chest X-ray was carried out and did not reveal anything abnormal. For a while afterwards, the claimant’s condition seemed to improve, although his parents remained concerned. The exact sequence of events later that evening was not clear due to some inconsistencies in the records, but it appeared that the claimant started to deteriorate again, and, as a result, a registrar suggested that a fluid bolus should be administered and requested blood tests. The bolus seemed to improve the claimant’s condition slightly, and despite the blood test results showing some signs of inflammation, he was discharged.
His parents remained concerned about his condition and that the blanching rash had become increasingly non-blanching, and took him back to hospital a short time later. On the second admission, it was recognised that he might be septic and a diagnosis of meningococcal septicaemia was subsequently confirmed. Unfortunately by that stage his condition had significantly deteriorated and he had to undergo an amputation of his left leg as a result of tissue and vascular damage.
After an investigation was carried out by Penningtons Manches’ clinical negligence team, it was alleged that there was a failure on the part of the paediatric emergency team to recognise that the claimant could potentially be developing sepsis and act accordingly (including a failure to adhere to the appropriate NICE guidelines). It was also alleged that he should have undergone a septic screen and that with appropriate care, antibiotics would have been commenced at an earlier stage, when they would have been likely to be effective in stopping the progression of sepsis. The hospital admitted that the claimant should not have been discharged when he was and had he been given antibiotics earlier, he would not have suffered the amputation. However, the hospital denied all allegations of failures prior to the decision to discharge him and claimed that at that stage alternative action would not have affected the outcome in any event.
Given the dispute, proceedings were issued and served. It was agreed that liability would be determined as a preliminary issue and the case proceeded some way through the court timetable. However, the defendants then indicated a willingness to negotiate and eventually a settlement on liability was agreed. The matter will now proceed by way of valuing the claim.
Philippa Luscombe, partner in the clinical negligence team who conducted the case, comments: “This was a very sad case in which the claimant’s parents clearly raised concerns about their son but were repeatedly reassured/dismissed. It was our case that there were a number of failures in his care and overall a failure to recognise the signs of developing sepsis, despite the known importance of diagnosing and treating sepsis early. Whilst resolving liability is an important step forward and should now enable a real difference to be made to the claimant’s quality of life, the facts of this case are that with proper care he would not have suffered the amputation and its consequences. We deal with a number of cases involving delays in the diagnosis of sepsis and/or meningitis, often in children, and it is frustrating when the signs were there and were missed. We hope that the recent spate of awareness about sepsis and its implications will help reduce these instances.”