Richard Malloy, a specialist Medical Negligence Solicitor at Gregory Abrams Davidson Solicitors, recovers damages for injuries and losses sustained due to negligent treatment at Ashford & St Peters Hospitals NHS Foundation Trust. The Deceased attended hospital but as a consequence of inadequate fluid therapy whilst an inpatient she developed renal failure and died. We were able to prove that her fluid management had been negligent and it was this which had ultimately caused her sudden deterioration and death.
The Deceased was undergoing chemotherapy for cancer. She attended hospital as an emergency having developed diarrhoea that was loose and watery, reduced oral intake and weakness. Her blood tests showed raised blood urea compatible with dehydration. She had no fever but was started on IV fluids, IV antibiotics, GCSF2 and loperanide in accordance with NICE chemotherapy guidelines. She was noted to be alert afebrile on examination.
She was reviewed next morning by acute oncology service which assist in the management of patients admitted to hospital with cancer who advised that the same management should continue.
She was given an estimated discharge of 2-3 days
On 2 March the acute Medical Consultant reviewed her at 1.00pm. Her CRP was 51 (normal range up to 20) and the neutrophil count was 0.3, but the blood urea which is a measure of dehydration had improved to 7.9.
The medical records indicate that diarrhoea and nausea continued and the plan for the weekend was to monitor the bloods and continue IV antibiotics and GCSF2.
On 4 March her EWS (early warning score) was 3 and her blood pressure was low (90/46).
On 5 March the acute oncology nurse reviewed her and noted that her neutrophils on 4 March were 0.6 her CRP was 131 and her blood potassium was low at 2 but that she spiked further fever of 39.9 at 8.00pm. The oncology nurse requested blood cultures as well as an acute oncology consultant review. At 2.30pm she was reviewed by the acute oncology consultant who noted diarrhoea 4 times so far that day and that she was feeling fatigued. The consultant advised that regular loperamide should continue along with GCSF2 and if recurrent temperature spikes occurred to discuss the antibiotic therapy with the microbiologist.
On the 6 March the records indicate that both urea (at 16.7) and creatinine was 129 and were both rising but only 1 bag of IV fluids was given. The neutrophil count was now 1.
On 7 March a physiotherapist/occupational therapist reviewed her and noted that she had not been out of bed for a week as she was feeling nauseous, dizzy and weak.
On 8 March blood tests showed a sodium of 151 urea of 25.5 and a creatinine of 170 at lunchtime the records indicate that she had worsening renal (kidney) function and a renal ultrasound was suggested as well as stopping the antibiotics. At 10.45pm the records indicate the EWS score was now 9. Bloods were repeated and oxygen administered. It is apparent that a decision was made for end of life care.
At 9.30 on 9 March she was seen by a medical consultant who noted that she was very unwell. Bloods showed a low serum lactate of 2.4 blood pressure was low, respiratory rate was high and critical care outreach was requested at 10.00am.
Her family were called into hospital on the morning of 9 March. They were shocked to discover that she had been moved out of a side room and was in a coma like state. The family were concerned that there was little or no understanding as to the events that had unfolded overnight leading to the significant deterioration in her condition which was unexpected.
The family were informed that their mother was seriously ill and may not survive. The fact that death was now a possibility was completely out of the blue and had never been raised previously. The focus had been purely on discharge.
End of life care was instituted on 9th March. The deceased died on 13 March and was aged 75 years.
The family made a written complaint to the Hospital Trust.
The Trust investigated the case internally and found no fault. They provided reassurance that the deceased had received good care stating we
“would like to reassure you that your mother received the correct care when she was admitted to hospital with intravenous antibiotics and G-CSF injections ….”
Despite this the family persevered with the complaints and this resulted in a further response and then a meeting at the hospital but the Trust maintained that the care received by the Deceased was good and did not identify or admit to any failings.
The family took their case to the Healthcare Ombudsman who investigated but their preliminary findings were not accepted by the Trust. Consequently those findings were not shared with the family and the matter was passed back to the Hospital Trust.
The Trust subsequently sent the family a Serious Untoward Investigation Report. This was technical and vague in its conclusions. The final conclusion was that
“There was a delay in recognition and management of renal impairment but the deceased had significant co-morbidities and frailty with low BMI, which may not have improved her chances of improvement to a stage of her being suitable for further active life prolonging treatment for cancer”.
Therefore in summary over a significant period of time and after much effort the family felt they had fully exhausted both the internal hospital complaints procedure and the Healthcare ombudsman and did not feel they had achieved the answers they were looking for.
Richard Malloy, a specialist Medical Negligence Solicitor at Gregory Abrams Davidson Solicitors was instructed by the family of the deceased.
We obtained voluminous disclosure from multiple sources. We liaised with the Healthcare ombudsman regarding their failed investigation which had been abandoned at the insistence of the Defendant Trust.
This led to the discovery that the Healthcare Ombudsman had identified serious failings which had not been disclosed to the family and the Trust had refused to accept.
After our investigations a formal Letter of Claim was drafted and sent to the Hospital Trust.
Formal allegations were put to the Hospital Trust including that:
It was alleged that as a consequence of inadequate fluid therapy the Deceased developed renal failure, which with the background of raised temperature with ongoing sepsis as judged by the episodes of fever resulted in her acute deterioration. With appropriate fluid management, the Deceased would have avoided the development of renal failure and on the balance of probabilities would not have died when she did.
The Hospital Trust investigated the case and subsequently responded admitting liability in full. The failures as alleged were admitted and it was accepted that but for the admitted breaches of care the Deceased would not have died.
The Parties reached a negotiated settlement in which the Defendant agreed to pay damages in respect of pain and suffering, loss of love and affection as well as funeral expenses and the family’s legal costs. The case settled without the need for Court Proceedings to be commenced.
The Trust subsequently provided a formal apology apologising unreservedly for the distress and suffering caused. They additionally provided the family with confirmation that as a consequence of their investigations changes to their internal policies had been implemented including a new consultant rota and treatment pathway. This was something that reassured the family who were very keen to ensure that other patients would not suffer in the same way their mother had.
Richard Malloy is a Solicitor and Head of Medical Negligence at Gregory Abrams Davidson Solicitors. Gregory Abrams Davidson Solicitors are Solicitors who specialise in obtaining compensation for clients who have sustained injuries as a result of Medical Negligence. We deal with claims for compensation against hospitals (both NHS and Private), dentists, general practitioners, pharmacists and opticians. We have offices in Liverpool City Centre, Allerton, Garston Village and Golders Green, London. We offer a free initial case assessment and No Win No Fee Funding is available To enquire contact a member of our Medical Negligence new enquiries team on 0151 733 3353, email This email address is being protected from spambots. You need JavaScript enabled to view it. or search GAD legal.