On the 2nd November 2009 the Deceased a young woman aged 31, was under the care of the Queen Elizabeth Hospital in her pregnancy with her third child and was well until 16 July 2009, when she attended the A & E Department, complaining of a severe headache. She was reassured and discharged. She was well thereafter.
On 2 November 2009, when she was 39 weeks pregnant, she was unwell and, at 0645, the Deceased's partner telephoned their out of hours GP service for advice. The Deceased appeared sleepy and complained of a headache and feeling dizzy. On the advice of the doctor, the Deceased called the midwives at the hospital but was advised to stay at home. She stayed in bed all day and her partner eventually left the house at about 1600 to make some essential purchases. On his return home at 1800, he found the Deceased unresponsive and, when roused, confused and speaking nonsense. He therefore called an ambulance.
The ambulance crew arrived at 1819 and found the Deceased to have a low Glasgow coma score and unreactive pupils. She arrived at the hospital at 1907 and was noted to be unresponsive and a venflon was sited. She was reviewed by ITU at 2000. It was recorded that the impression was ? post-ictal and that she should be referred to the medical team. It was recommended that she should have a CT scan if her Glasgow coma score did not improve.
At 1945, there was a power cut at the hospital and the back-up generators were implemented. These did not support the air-conditioning. The room containing the servers and the PACS system for transmitting scans overheated and the services closed down at about 2300.
She was recorded as very unresponsive, responding only to pain. She was reviewed by the obstetric registrar whose retrospective note is timed at 2100. She recorded the history taken from the Deceased's partner, found the pupils to be sluggish in reaction to light and the reflexes to be normal, informed the obstetric consultant, and, after a telephone discussion with the radiology consultant on call, ordered a cranial CT scan. The radiologist who was at home, spoke to the Radiographer and awaited the imaging which was to be transmitted direct to his PC by the PACS system.
A further note of review by the on-call medical team is untimed and notes a GCS of 8/15, agitation and aversion to light and a differential diagnosis of cerebral haemorrhage or infection was made and an urgent CT scan ordered. She was given antibiotics and anti-viral drugs.
The CT scan is shown to have been ordered at 2017. Although the CT scanner was ready from about 2035, delays in intubating the Deceased led to the urgent scan not being undertaken until 2325. The Deceased was exhibiting signs of raised intra cranial pressure but these were attributed to agitation and she was sedated.
There was further delay caused by lack of appreciation of the fault with the PACS system and the radiologist had to drive to the hospital to view the imaging. He arrived at the hospital at 0130 on 3 November 2009. He found that the Deceased was suffering from hydrocephalus affecting the lateral ventricles caused by an obstruction (which proved to be a colloid cyst) at the level of the foramina of Munro plus cerebral swelling. He advised that she required urgent neurosurgical treatment.
As the hospital did not have a neurosurgical department, attempts were made to find a bed at either King's College Hospital or St George's Hospital. Delays ensued as a result of technical difficulties sending and printing the CT scan imaging and yet further delays were caused by the London Ambulance Service when a blue light transfer was requested at 0342. Further delays ensued when the ambulance arrived at 0422 due to a connector for the portable ventilator not being available and the Deceased was not ready to be transferred until approximately 0500. However, these further delays were, we believe, of no causative significance as she was, in our experts' opinion, beyond saving by 0200 on 3 November 2009.
The Deceased was admitted to St George's Hospital at 0545, where it was noted that her pupils were fixed and dilated. She was taken straight to theatre, where external ventricular drainage was undertaken and then her baby was delivered by caesarean section at 0614. Brain stem death tests were completed at 1350 on 4 November 2009 and ventilation was withdrawn. The Deceased was certified dead at 1110, the time of the first brain stem death test.
The allegations of negligence were:-
- a. Unacceptable delay in carrying out an urgent CT scan: this should have been accomplished by 2100 on 2 November 2009 and would have led to urgent transfer to a neurosurgical unit.
- b. Unacceptable lack of knowledge and inadequate communication in respect of the effects of a power failure upon the imaging technology at the hospital and a consequent delay in diagnosis.
- c. Unacceptable lack of knowledge of the hospital's protocol for the management of ventilated and neurologically injured patients and consequent failure to follow the protocol.
- d. Unacceptable failure to recognise the signs of raised intracranial pressure.
A detailed Letter of Claim was sent to the Defendant Trust on the 16th May 2012. Fortunately the NHSLA recognised that the Defendant's deficiencies of care were responsible for the Deceased's death and made an admission of liability on the 6th June 2012 and the Deceased's partner was sent a letter of apology on 12th June 2012.
A Part 36 Offer was originally made in the sum of £350,000. The damages included a claim for the past loss of services of the Deceased and the loss of earnings for the Deceased. It also included the claim for funeral expenses, bereavement award, loss of dependency upon the Deceased's earnings and loss of dependency upon the Deceased's services of the partner and mother and the loss of their mother's love and affection.
Once the case was settled the children had apportioned to them sums for the loss of their mother's natural love and affection.