Guest blog from Stuart Bramley, Partner of Tozers www.tozers.co.uk
Tozers LLP were recently successful in obtaining an admission of negligence in a complex claim where Alyssa Richardson developed the infection Group B Streptococcus (GBS) in the hours after her birth in 2013.
“In labour, Alyssa’s mother Rachel was found to have two risk factors – a high temperature; and her waters breaking more than 12 hours before delivery. When combined these factors gave a GBS risk of 12 times that of most expectant mothers. When Rachel arrived at her local hospital in labour she had a swab taken and was told this was for MRSA. When Alyssa was 12 hours old (36 hours after the swabs were taken) a midwife came to Rachel on the postnatal ward and asked whether she had ever heard of GBS, since she was in fact colonised with this. Rachel was given a leaflet about the infection and having read this, and learning of the risks arising both from her high temperature in labour and from prolonged rupture of the membranes (her own waters having been gone some 23 hours prior to delivery), Rachel asked to be given precautionary antibiotics. She was told she would need to talk to a paediatrician as the midwife didn’t have much knowledge of GBS. Rachel spoke to a paediatrician about the possible link between this colonisation, her own high temperature and the prolonged rupture of the membranes and requested that Alyssa be given precautionary antibiotics. Rachel was told that Alyssa was fine and that for antibiotics to be administered a cannula would need to be inserted which was difficult in a newborn and would require two doctors so it could take a few hours for people to become available. Rachel however insisted on this being done and this was agreed to, although in the event the precautionary antibiotics were never given.
Alyssa was born via emergency C-section due to Rachel’s labour not progressing past 6 cms. Approximately 11-12 hours after the delivery, Rachel and her partner Aaron noted that Alyssa had started to make grunting noises. They raised this with the midwife who, without herself checking the noise, reassured them and suggested that this would have been because the baby may have inhaled amniotic fluid. However, an hour later Rachel noted that Alyssa had also developed purple blotches, spreading mainly on the face. Alyssa was taken to the resuscitaire and another midwife told Rachel that this was “because Alyssa was of mixed race” and she had seen it many times before. Alyssa was also lethargic and unresponsive and so was checked over by the midwives and a paediatrician. Blood gases were taken and it then took three doctors several attempts to insert a cannula for antibiotics. Once the cannula was finally inserted Alyssa was transferred to SCBU and although the parents were again reassured that this was just for a little help with her breathing, they later found out that at the time the doctors caring for the baby had suspected that there was sepsis (infection). The intention was to give intravenous antibiotics but in the event those were not administered for a further 2 hours after the cannula was inserted – this was over 5 hours since Rachel had requested them as a precautionary measure. This delay was partially due to SCBU wrongly assuming that the postnatal ward had administered them when the cannula was sited.
During this period without antibiotics Alyssa deteriorated significantly. This resulted in the purple blotches the parents had seen on Alyssa’s face becoming more widespread with her legs and hands starting to turn black, her eyes rolling backwards into her head and her limbs twitching. These alarming symptoms were nonetheless not taken seriously by the SCBU nurses and, after being told for hours by the nurses that her baby’s high temperature was causing poor circulation and that this was the cause of the twitching and causing her limbs to look black, Rachel demanded that a doctor be called. The parents were told that the doctors were attending to an emergency. When a doctor finally came he seemed to acknowledge the severity of her condition and within an hour he explained that Alyssa was critical – sepsis had taken over her limbs and she was having severe seizures. It was felt that no more could be done there for Alyssa and she was transferred to a specialist unit in a different city, where upon arrival she was confirmed as having suffered GBS septicaemic shock and meningitis.
Despite her critical condition, the efforts of the staff at the second hospital saved Alyssa’s life although subsequent tests showed that she had suffered an unidentified degree of brain injury. The meningitis and sepsis also led to very extensive scarring across the legs and arms. There had also been growth plate damage to both legs, which is now thought likely to require several operations in future to allow her limbs to grow unimpeded.
At age 3, Alyssa Richardson is now a delightful girl although it is clear that the cerebral injury sustained during the period of meningitis will create increasing difficulties as she gets older. She has developmental delay and learning difficulties and remains under regular medical input at present, and this is likely to continue for the foreseeable future.”Alyssa’s legal claim was handled by Tozers’ partner and solicitor Stuart Bramley who has extensive experience of group B Strep claims, having been one of the original two solicitors on the legal panel of the charity and campaigning group Group B Strep Support since the panel’s inception. Despite the standard of medical care having previously been defended by the hospital when Alyssa’s parents brought an NHS complaint, Stuart nonetheless secured an open admission of liability.
Alyssa’s legal action is far from over, however. Her prognosis remains uncertain and it is unknown how much surgery she will require on the growth plates and scar tissue across her legs. At age 3, the extent of any brain damage arising from the meningitis is still unclear although she benefits from both the input of various health professionals and the constant love and support of her parents. Stuart Bramley notes,
“This story illustrates the constant risk of GBS to newborn babies – current studies show that in the UK it affects around 1 per 1,000 births. Early administration of antibiotics is extremely effective but this obviously depends on clinicians realising that the mother and/or baby have GBS in the first place and as Alyssa’s experience shows, even very obvious risk factors can be overlooked; clear signs that a baby has developed the infection can be misdiagnosed; and when Strep B is finally identified, there can sometimes be unforgivable delays in giving antibiotics. I wish Alyssa every success in the future; and I wish the NHS would heed organisations such as Group B Strep Support who tirelessly campaign for routine testing for all pregnant women”.