Trust’s failure to ensure new mother understood feeding instructions could have wider implications for care standards

Posted: 30/04/2018

A Sri Lankan mother who could not speak English has recovered substantial damages against Barking, Havering & Redbridge NHS Foundation Trust for the serious brain damage suffered by her baby son due to a lack of appropriate feeding. She did not understand the instructions she was given on feeding a newborn baby while in hospital and was discharged too early.

Nilujan Rajatheepan was healthy when he was delivered by caesarean section at King George Hospital in Goodmayes, Essex. He was born to young parents who are Tamil refugees. His mother tried to raise concerns about the baby’s continuous crying and issues with feeding while in hospital but these concerns were not understood or addressed. She and her baby were discharged home with no guidance about feeding and no attempt to address the difficulties that she was experiencing. When the community midwife visited the family, she found the baby to be in a poor condition with hypoglycaemia due to lack of adequate nutrition. Despite being admitted to hospital, he was left with brain damage and permanent disability.

Investigations into the events leading to Nilujan’s injury revealed that the midwives at St George’s Hospital were aware that this was his mother’s first baby and that she had extremely limited understanding of English. Despite guidelines being in place on arranging interpreters in such situations via the NHS language line, the midwives took no steps to either obtain an interpreter, see if the family had anyone who could assist in translation or ensure that the parents understood what care Nilujan needed and what to look out for before he and his mother were discharged.

The court held that the midwifery care fell below an acceptable standard and that Nilujan’s lack of nutrition and consequent injury were a result of a lack of communication and understanding. Had his mother’s concerns been addressed and had she been given proper instruction, staying in hospital for another night, his injuries would have been avoided. In his ruling, the judge commented: “The sad reality is that Mrs Rajatheepan did not, in fact, ever get any instruction on how to feed properly...Still less did she receive any instruction on what to look out for and what to do if feeding was unsuccessful."

Damages have yet to be assessed but will be substantial.

Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, said: “This is obviously a tragic case featuring a young and worried mother who simply was not able to care for her newborn baby because of a lack of support and communication. He suffered permanent and avoidable injury because the midwives at King George Hospital did not take steps to ensure that he was feeding properly and that his mother knew what to do before sending them home.

“The significant thing about this case is whether it may be used in a wider context. In our experience as a clinical negligence team, a high number of claims revolve around breakdowns in communication between medical staff and patients. Of those cases where such failures are the cause of injury, a number do involve a language mismatch. Sometimes English is not the claimant’s first language and he or she does not understand fully what has been said or struggles to communicate issues effectively, as in this case. On other occasions, the issue is that the medical staff have restricted English language skills and communication. Either way, we see cases where a lack of understanding between doctor/nurse and patient has resulted in avoidable problems and injury. This case may be the start of a higher standard of care being imposed on medical staff to ensure that where important instructions are being given to patients, they (or someone with them) clearly understand the details given. It will be interesting to see if this issue evolves given the wide range of nationalities and languages that coexist in the UK.”

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