Abstract
Facts
MM (born on 15 May 1975) was pregnant with her third child and her antenatal care was received from both her GP and the hospital. She had not suffered any problems with the previous two pregnancies and had normal vaginal deliveries. It was noted that during her pregnancy she had high blood pressure and, therefore, she received Labetalol 200 mg.
MM attended at the GP surgery to see the midwife on 28 June 2006 and, following examination by her, it was decided that she needed to be admitted to Hope Hospital. This occurred because her blood pressure was so high at this point and could not be reduced despite the efforts tried by the medical staff. It was decided to induce the labour and, therefore, MM was transferred to the labour ward on the night of 28 June 2006. The delivery took place with an interpreter present as MM originates from the Democratic Republic of Congo.
The induction was very slow and nothing was said to MM during the labour and delivery about the baby being in any difficulties. She recalls that at approximately 14:00 on 29 June 2006 the attending medical nursing staff spoke about using syntocinon in order to speed up the labour. A CTG monitor was in situ and the baby's heartbeat was monitored throughout the labour and delivery. After a long labour, HK was delivered at 21:10 on 29 June 2006.
HK was born in a good condition. Unfortunately, it was not possible for MM to breastfeed him immediately as she had no milk. HK began to cry and so there was an attempt to feed him but this was not possible. He was quite agitated during the night, he cried frequently and he wouldn't take any milk. MM was worried about this and told the staff but everybody said that everything was fine. The interpreter had left at this point. MM requested help from the midwife yet none of this is noted in the medical records.
On the morning of 30 June 2006, HK's temperature dropped and he was placed on a heated pad. MM was very worried and concerned about him. He kept crying but the medical staff dismissed her concerns. The paediatrician checked HK over and said everything was fine. He still at this point had not fed very well and was crying.
MM was discharged home with HK at approximately 20:00 on 30 June 2006 and MM arrived home at 20:15. When she left the hospital HK was quiet. They reached home and she changed his nappy and was able to feed him. HK fed and then he fell asleep and so was put in his cot. MM checked him 30 minutes later and he seemed well. She then went to have a shower and when she had done this she checked him again and found that he wasn't moving or breathing. MM called an ambulance straight away and her partner administered CPR, being told over the telephone by the ambulance crew what to do. The ambulance crew arrived very quickly and put HK in the back of the ambulance, they tried to resuscitate him but sadly he had died by the time they reached the hospital.
A postmortem report was undertaken and showed that baby HK died from group B Haemolytic streptococcal (GBS) pneumonia.
Evidence
Independent medical evidence was obtained from a consultant paediatrician. The paediatrician confirmed that there could be no doubt that HK died of GBS pneumonia. He highlighted that this was a condition well-known to all paediatricians. It was stated by the expert that the onus is on the Midwifery and Neonatal Team to identify any baby who is unwell in the newborn period; the most common signs are poor feeding and temperature instability.
The expert concluded that a high dose of antibiotics by late afternoon on 30 June, rather than being allowed home at 20:00 would probably have saved HK's life. The expert highlighted it was very difficult to assess the standard of care in this case as the notes were very sparse, however, the expert noted that MM's recollections were totally consistent with what they would expect of a baby with early neonatal sepsis.
The expert stated that the difficulties in maintaining HK's temperature and poor feeding on 30 June are early signs of neonatal sepsis. If HK had been referred back to the paediatrician on 30 June, it is likely that the paediatrician would have realized that sepsis was possible and high doses of intravenous antibiotics would have been started by late afternoon and on the balance of probabilities, HK would not have died.
Proceedings
We were originally instructed by MM to represent her at the Inquest into her son's death and pursued a clinical negligence case after this. The Coroner gave a narrative verdict at the Inquest which was that HK died of a naturally occurring infection that was acquired in the womb or during his birth at Hope Hospital, Salford on 29 June 2006. While he was in hospital, he had difficulty in feeding and an episode of low temperature and an episode of increased respiration rates. There is no record of his low temperature or increased respiration rate having been monitored after they were first noted. The Coroner made it clear during the course of the Inquest that monitoring was the key and there was no evidence that this had happened after 13:30 up to HK's discharge at 20:00 or thereabouts. The Coroner spoke directly to the representative from the Legal Department from Hope Hospital and clearly indicated that he should advise all of the doctors and nurses in the hospital that record-keeping was vital.
A Pre-Action Protocol Letter of Claim was served on 10 January 2008. The Defendant sent a Letter of Response on the 21 July 2008 which in some respects was an acceptance of responsibility, as they accepted that there was a failure to record the monitoring/assessments of HK prior to his discharge home. However, there was a denial of causation of injury as the Defendant said that had appropriate monitoring and observations been undertaken on the afternoon of 29 June, they would not have shown that HK had any difficulties nor would there have been any need for antibiotics to have been provided.
The Defendants did make a Part 36 Offer on 7 November 2008 for the sum of £7500. This was rejected and the Claimant made a counter-offer of £13,125.
There followed a series of offers and counter-offers which were rejected. Proceedings were served on 13 February 2009. The Defendants made a further offer of £13,000 which was accepted.
An approximate breakdown of the damages is as follows:
£10,000 £1000 Balance
There was no claim by MM for damages for psychiatric injuries, as it could not be shown that she had sustained any psychiatric injury directly related to her son's death.