Case settles for parents of dehydrated toddler who died at Great Ormond Street Hospital

Ellen Parry and Henry Dyson, of the Leigh Day clinical negligence department, have settled a case on behalf of the parents of a toddler who died at Great Ormond Street Hospital, “GOSH”.  GOSH admitted liability for the death of the 22-month old.

R, who suffered from cerebral palsy and development delay, had been diagnosed with presumed aspiration pneumonia on 21 November 2008. She was also suffering from severe diarrhoea.

On 22 November 2008 R was intubated and admitted to the Paediatric Intensive Care Unit at Great Ormond Street Hospital. She had to be fed via a gastrostomy tube but pus around the gastrostomy site meant that all feeds were stopped and replaced with IV fluids. 

Feeds were restarted though a nasogastric tube at a very minimal rate during the night of 24 November 2008.  On 25 November 2008, IV fluids were reduced and the tube feeds were increased. Unfortunately, feeds were re-established very slowly and the IV fluids were stopped completely that afternoon so that R received just 60% of her normal daily fluid requirements.  In fact, R required more than her usual daily requirements because of her consistently high temperature and diarrhoea.

The following day, 26 November 2008, R was becoming increasingly dehydrated and her heart rate was very fast.  R’s parents were worried that she was deteriorating and asked for help, but no additional concerns were noted. A very high sodium level had been noted by a junior doctor, indicating that R was dangerously dehydrated with too much sodium in her bloodstream but still this did not prompt further review or action.

R’s parents continued to plead for additional attention, feeling that their daughter was slipping away. R’s father became unwell due to the stress and anxiety arising out of her treatment. Eventually, at 7.00pm, it was appreciated that R was dehydrated. She had a very high temperature, her heart rate was slowing and her breathing became quick gasps and she was unresponsive.  Prolonged, unsuccessful attempts were made to put a cannula into R’s arm to enable fluid hydration, but it was not until 10.40pm that an anaesthetist was eventually called. Having been profoundly shocked for some time, R was taken to theatre to try to place the cannula.  Sadly, she sustained a cardiac arrest from which she could not be resuscitated.

Expert evidence confirmed that R had been given insufficient fluids and that there were several failures to appreciate the significance of her observations, respond to her deteriorating condition and escalate her care.  The Trust’s own investigation had highlighted concerns including the delay in responding to the high sodium result, the length of time that had been taken to try to attempt cannulation, the fact that there was no clear pathway for ensuring timely IV access and the delay in calling the clinical emergency team when faced with a clinical emergency situation.  With appropriate care, R would have survived.

Following Leigh Day’s investigation, the Trust admitted liability for R’s death and formally apologised to the family. Unfortunately, both parents sustained psychiatric injuries as a result of their experiences and will be undergoing trauma-focused treatment. 

Leigh Day negotiated a significant sum of compensation for R’s parents, who hope that in bringing this case they have raised awareness within the Trust of the importance of providing adequate hydration and escalating the care of seriously sick children.