Whittington Health NHS Trust settles claim for negligent treatment of Second World War veteran

Lester Wilson, who was originally from Jamaica and had served in the Royal Air Force during the Second World War, died aged 90 following multi-organ failure two days after he was admitted to Whittington Hospital in London.

In a legal claim against the hospital by Dee Wilson, it was argued that the failure to give Mr Wilson doses of his hydrocortisone medication caused a rapid deterioration in his condition. If he had been given his hydrocortisone he would not have become cortisol deficient and would have been treated successfully and recovered.

Whittington Health NHS Trust admitted a breach of duty but denied that caused or contributed to Mr Wilson’s deterioration and ultimately to his death. However, the Trust settled the claim shortly before it was due for trial at the High Court. 

The claim was brought under the Law Reform (Miscellaneous Provisions) Act 1934 for the benefit of the estate, and under the Fatal Accidents Act 1976.

Mr Wilson had a history of hypopituitarism, a hormone disorder for which he was dependent on the steroid hydrocortisone which he was taking in the community to replace the hormone cortisol. Mr Wilson was prescribed 10mg hydrocortisone in the morning and 5mg in the evening.

An expert instructed on behalf of Mr Wilson’s family reported that during periods of illness, it is vital that steroid-dependent patients are given increased doses of hydrocortisone in order to prevent acute cortisol deficiency – known as adrenal crisis – which can lead to rapid deterioration and death. Patients experiencing adrenal crisis need to be given an emergency dose of 100mg hydrocortisone followed by increased doses of hydrocortisone over 24-hours.

In October 2012 Mr Wilson had been admitted to hospital for several weeks. A permanent pacemaker was fitted and he spent some time in intensive care. However, he was discharged on 20 December and had enjoyed such a quality of independent life that he was able to drive his car.

However, early in 2013 Mr Wilson’s condition deteriorated over the course of a week and he complained of chest pain. On 16 January an ambulance was called and he was taken to Whittington Hospital. Mr Wilson had had his last dose of hydrocortisone at 7.45am and a doctor at the hospital noted his medical history including 10mg of hydrocortisone to be taken in the morning and 5mg in the evening.

Mr Wilson was not given hydrocortisone at any time following his admission. At 4am on 17 January a doctor made provisional diagnoses of acute kidney injury, a chest infection, and acute coronary syndrome. The plan was for repeat blood tests, a chest x-ray, intravenous antibiotics and fluid treatment. By this time Mr Wilson was significantly cortisol deficient.

At 11am a consultant doctor’s note showed Mr Wilson had clearly deteriorated significantly since his admission and was significantly cortisol deficient. He was admitted to the intensive care unit at 3pm.

At 5pm doctors had a conversation with Mr Wilson’s son Dee who explained that his father had enjoyed a good quality of life before his latest admission to hospital. It was by this time 33 hours since Mr Wilson’s last hydrocortisone medication and he was suffering the severe effects of cortisol deficiency.

By the time of the night ward round, doctors recorded that Mr Wilson had developed multi-organ failure with a very poor prognosis and at 1.10am he went into cardiac arrest and died.

Dee Wilson alleged in a letter of claim sent by Leigh Day partner Emma Jones to Whittington Health NHS Trust that the hospital had been negligent in failing to administer steroids to Mr Wilson. Dee Wilson alleged although he had been unwell when he was admitted to hospital, no clear source of infection was identified, and had he lived, an infection would have been treated with antibiotics that were prescribed. His kidney function was reversible. However, if the hospital had not been negligent, Mr Wilson would have been prescribed an increased dose of steroids and would not have become cortisol deficient, which led to his rapid deterioration.

Expert medical evidence confirmed that the hospital should have given Mr Wilson an immediate dose of emergency hydrocortisone followed by increased doses of hydrocortisone throughout his admission to the medical ward and intensive care unit.

Emma Jones said:

“Lester Wilson was advanced in years, but he had made an excellent recovery from his previous stay in hospital and was enjoying a good quality of life. His family believe that if he had not missed out on his vital steroid medication then he would have made another good recovery from what was only a setback. If he had not been negligently treated at Whittington Hospital, then Lester would have recovered and been discharged.”

Dee Wilson said:

“My father's very rapid deterioration and sudden death did not seem right to me. For almost 10 years I have been determined to establish that my father’s death was not simply due to his advanced age but was due to a fatal adrenal crisis. Although I accept that my father was admitted to hospital with additional issues, the medical expert opinion agrees that my father’s symptoms did indicate an adrenal crisis. What is particularly important to me is that this claim brings attention to the importance of giving steroid-dependent patients their hydrocortisone medication. I am extremely grateful to my legal team at Leigh Day and to barrister Richard Borrett for representing me, and also to the medical experts who provided their opinions.”