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Settlement agreed with NHS Trust after avoidable death of a patient at Northwick Park Hospital

A settlement has been agreed with a NHS Trust after a coroner ruled neglect as the cause of death of a patient.

Posted on 11 March 2019

Solicitors at Leigh Day have agreed a settlement with London North West Healthcare NHS Trust on behalf of the family of Puspa Monji, after a Coroner ruled at an inquest in August 2018 that her death had been caused by neglect.

Puspa had been admitted to Northwick Park Hospital for an abdominal hernia repair in February 2018. She was fitted with a nasogastric tube during her recovery on the ward so that food could be safely administered directly into her stomach.

It is standard medical practice to check the positioning of the tube before commencing any feeding, given the risk of the tube being threaded into the lung instead of the stomach. This is done by carrying out a test to check for stomach acidity and/or carrying out an x-ray, or sometimes both.

Puspa had an x-ray to confirm her tube’s position and it was reported as showing the tube to be in an unsafe position. Unfortunately, the clinical staff reviewed the wrong x-ray report and thought that the positioning was safe. A nurse had, meanwhile, attempted to obtain a pH sample to test for stomach acidity, but had been unable to get one. Feeding was commenced in any event, as they believed the x-ray confirmed the tube to be in the correct position.

Soon after the feeding started, Puspa began to complain of increasing pain. Although initially dismissing the pain as constipation, the nurses later stopped the feed and a doctor requested a further x-ray. This x-ray confirmed that the tube was in the wrong positon but, by this time, about 200ml of feed had been delivered into Puspa’s lung.

Sadly, Puspa developed aspiration pneumonia caused by the feed and there was nothing that could be done to save her.

At an inquest in August 2018, Senior Coroner Andrew Walker concluded that Puspa had died due to “consequences of medical treatment contributed to by neglect”. He added that “there were many opportunities to prevent Mrs Monji’s death” and raised concerns that a number of failures coincided to contribute to the death.

The Trust admitted liability for Puspa’s death and confirmed that measures have been taken, at the Coroner’s request, to minimise the risk of future deaths of this type, including more stringent checks regarding the positioning of nasogastric tubes and new radiological procedures to minimise the risk of confusion over x-rays in future.

On the basis of the evidence obtained at the inquest of the unnecessary suffering that Puspa had been put through, Puspa’s family, together with Leigh Day, investigated a claim for clinical negligence. A settlement was reached with the Trust in January 2019 to reflect both the tangible and intangible losses brought about by Puspa’s death. Puspa’s family had already indicated that they would be using the entire five-figure settlement figure for charitable causes in Puspa’s name.

The family and the Trust are also in talks over a suitable memorial for Puspa and it is hoped that a hospital bench will be dedicated to her memory.

Solicitor Michael Roberts, from Leigh Day’s clinical negligence team, said: “This was a tragic and unnecessary loss of life. The Trust has recognised this in the settlement and in the improvements they have made to their clinical practices. We hope that the goodwill displayed will continue as the family and the Trust discuss between them a suitable way in which to honour Puspa’s memory.”

Kishan Parshotam, Puspa’s grandson, said “We would like to thank Michael and Paul, and their respective teams, for the work they did to uncover the negligence and neglect by Northwick Park Hospital. Puspa, or Ma as we fondly called her, was the head of our household and a strong, independent and influential woman. We will be looking to use the settlement towards strengthening the lives of girls so that they, too, can grow to be independent influencers in their own families.”

Leigh Day worked with Barrister Paul Reynolds of One Crown Office Row chambers.