Posted: 22/03/2018
Penningtons Manches is supporting World Tuberculosis Day which takes place on 24 March each year to help raise awareness of the disease.
Although tuberculosis (TB) can be treated, if there is a delay in treatment, the disease can prove to be fatal.
Emma Beeson, an associate in the clinical negligence team at Penningtons Manches, has represented numerous families who have lost loved ones followings failures by hospitals in England and Wales to recognise and treat TB.
Emma recently settled a claim against Aintree University Hospitals NHS Foundation Trust for the family of a mother and grandmother who tragically passed away after hospital staff failed to diagnose and treat her for TB, despite obvious warning signs, in time to save her life.
Mrs Norma Donohue, aged 72, suffered from severe ulcerative colitis. In July to August 2014 she took three doses of Infliximab, a drug used to treat ulcerative colitis which is also an immunosuppressive. Mrs Donohue and her family were not informed of the risk that any latent TB could become active after taking the drug which can lower the body’s natural defensive barriers.
Mrs Donohue was also not asked about any history of exposure to TB, and so the doctors were not aware that she had lived next door to a relative who suffered from the disease some years before. She was not issued with a Patient Alert Card which would have identified that she was taking Infliximab and provided the symptoms of TB that she should watch out for.
On 16 September 2014 Mrs Donohue presented to Aintree University Hospital with sharp chest pain, pain in her back and a fever. She was admitted to the hospital but it took 16 days before staff recorded in her medical records that she had been taking Infliximab. During this delay, Mrs Donohue became more and more unwell with no explanation for what was causing her infection. She suffered a great deal of pain, spiking temperatures and delirium. The doctors recognised that she had a serious infection but they could not work out what it was.
Despite Mrs Donohue’s Infliximab treatment being recorded in her notes, it took another four days before a doctor recorded that Infliximab and TB went “hand in hand”. Tests for TB were ordered but, despite this, doctors stipulated that no treatment for TB should be given before a diagnosis was confirmed.
This was incorrect and goes against clinical guidance which states that, where there is a high clinical suspicion that the patient has TB, treatment should be commenced.
Mrs Donohue’s daughters pleaded with the doctors to provide her with treatment as their mother continued to suffer horrific symptoms. She was extremely unwell and required so much care that the doctors asked two of her daughters to stay at the hospital day and night to assist with 24/7 care as it did not have the nurses available to provide this.
Despite a test for TB coming back as positive on 17 October 2017, no treatment was given. Mrs Donohue remained in hospital without any treatment until finally a decision was made on 31 October 2014 to commence anti-TB medication. A decision was also taken to transfer Mrs Donohue to the Royal Liverpool Hospital, where she continued her treatment.
Despite showing brief signs of improvement, treatment had been given too late and Mrs Donohue’s symptoms deteriorated. She sadly passed away on 15 November 2014.
A post-mortem examination confirmed that Mrs Donohue died of miliary tuberculosis.
Penningtons Manches carried out a clinical negligence investigation and obtained evidence to suggest that there were numerous failings in Mrs Donohue’s care. The doctors should have treated Mrs Donohue sooner and, had they done so, she would still be alive today.
Mrs Donohue’s family were understandably heartbroken to learn that their mother would have survived if she had been treated in time. The defendant trust sought to deny any wrongdoing but, after discussions, eventually made an offer to settle the claim.
The trust never formally admitted the failings in Mrs Donohue’s care but was asked to provide the family with a letter of apology. The family hoped that this might encourage the hospital to learn from its mistakes, ensuring that no other family would have to suffer the same failings, and would also provide them with closure after losing their mother. However, no apology was given.
Emma Beeson said: “This is a tragic case and I know that the family of Mrs Donohue is heartbroken. Her daughters want to ensure that their mother did not die in vain and to know that lessons can be learnt from what happened. They would like people to be aware of the signs and symptoms of TB and to know that it is not just an active disease but can also be latent. If a patient has a condition or is undergoing treatment which lowers their immune system, it can cause any latent TB to become active.
“Medical guidance is clear that, if there is a high suspicion that a patient has TB, treatment should be commenced. The doctors in Mrs Donohue’s case refused to treat her until they had positive findings to confirm a diagnosis of TB. The problem is that it is very hard to test for TB and that is why treatment should be commenced as soon as there is a high clinical suspicion of the disease.
“Mrs Donohue’s family are not the first family I have acted for where a hospital has negligently failed to diagnose and treat TB in time to save the patient’s life. My hope is that, by continuing to raise awareness of this disease and how it should be treated, these tragedies will not be repeated.”
Whilst TB can now be treated, around 1.7 million people per year still die from TB, many of whom live in socioeconomically deprived countries. World Tuberculosis Day aims to promote a greater awareness of this disease among both medical professionals and the general public.
TB is a bacterial infection that can cause the death of tissue in any organ in the body. Most commonly found in the lungs, TB is a contagious disease that can spread through contact with the saliva of a TB sufferer (eg by being near them when they cough or sneeze) and it can stay latent or dormant within the body, without symptoms. The disease is most likely to become active in patients with a lowered immune system, whether this is caused by low body weight, old age, illnesses such as diabetes or HIV, or immunosuppressive medication.
How is TB diagnosed?
Usually, doctors who suspect a patient may have TB will carry out a chest X-ray and take sputum cultures to check for the presence of TB bacteria. These bacteria are slow-growing when compared with other disease-causing infections, and therefore TB treatment should sometimes be started before the cultures can be confirmed as infected, to ensure that it is initiated in time to save the patient.
Why is greater awareness important?
Earlier this month, it was reported that GPs and pharmacists in East London have trialled new record-sharing software for patients with latent TB to try to avoid information about the risks associated with TB being lost between care providers. The new software allows pharmacists to view patient records and correspond back to the GP or make a referral, which helps them to identify and treat the dormant form of TB before it becomes active. This is a positive step towards the medical profession sharing information and decreasing the risk of death from TB in the UK.
If you or a loved one have concerns regarding a failure by medical professionals to treat TB, our specialist team may be able to help.
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