What was the case about
We were instructed by the parents of Miss B who sadly died at the age of 6 months of pneumococcal meningitis which is a life threatening inflammation of the lining of the brain and spinal cord. Miss B’s parents were concerned about their daughter when she became lethargic and didn’t want to feed or drink. They took her to an out of hours GP who advised this was a viral illness and that they should take their daughter home and continue to give her Calpol and return if she is no better. They followed the advice of the GP but 18 hours later she was admitted as an emergency patient to hospital by ambulance. On arrival at hospital she was resuscitated and intubated and transferred to the intensive care unit. She remained critically ill and pneumococcal meningitis was diagnosed. Despite intensive antibiotic therapy Miss B did not regain consciousness and after one week in hospital her parents were asked for permission to switch off her life support resulting in her death in hospital.
What did we do
Miss B’s parents lodged a complaint about the appointment with the out of hours GP. Their concern was that a reasonable examination of their daughter was not done. In particular their daughter’s temperature was not taken and the GP did not remove Miss B’s clothing to examine her chest or back. Their concern was that the appointment amounted to nothing more than a cursory glance at their daughter and the GP had not appreciated the parents’ report of the amount of time their daughter had not been feeding or drinking and the GP did not appreciate how lethargic their daughter was. In the response to the complaint the GP admitted to not taking the baby’s temperature. However, it was denied there was any negligence in the way the appointment had been conducted or the advice given. It was further denied that even if the GP had recommended the baby be taken to hospital she would have been admitted for treatment and thus it was denied her death could have been avoided. The parents found this response difficult to accept and again felt that their concerns about how poorly their daughter was when they took her to the out of hours service had been overlooked. We obtained legal funding for the parents to investigate a clinical negligence claim against the out of hours GP. We obtained independent GP, microbiology and paediatric expert opinion. All experts we instructed considered that the attendance of the GP had fallen below a reasonable standard of care and they felt that with a 6 month old baby and the presentation of lethargy and a history of not feeding, she would have been admitted to hospital for investigation. It was felt that her death could have been avoided.
How did we help our client
We investigated the claim, including getting a psychiatric opinion for both parents for their secondary victim claims, which gave them both a greater understanding of what had happened during their daughter’s illness. By being able to discuss the independent GP expert opinion it reassured the parents their initial feelings of anger and being let down by the GP were valid. We also submitted a letter of claim to the Medical Defence insurer of the GP. This was met with an immediate denial of liability but an acknowledgement of risks associated with litigation and a small offer of settlement was made. This was refused and negotiations continued. These negotiations ended with an offer of settlement to both parents reflecting the degree of injury suffered by both of them as secondary victims and acknowledging the death of their daughter.
What the case highlighted
The expert opinion in this case identified the practice and procedure adopted in the NICE guidelines of 2007 which not only should be considered by doctors admitting children into hospital but also by all general practitioners involved with seeing children who present with the symptoms of a fever without an apparent source of infection. Expert opinion identified that whilst the majority of these children will have a simple viral infection, a small proportion will have a serious bacterial infection and left untreated these may have serious consequences as they did in this case. Had the out of hours GP considered the history given by the parents, taken account of how lethargic the baby was and taken her temperature, together this should have given rise to a high suspicion of the possibility of a serious bacterial infection and admission to hospital was needed.
This case was handled by Sarah Huntbach an Associate in our nationally recognised Clinical Negligence and Personal Injury Department. She can be contacted on 0121 212 7479 or by email at sarah.huntbach@anthonycollins.com.