Case of note: Anna Callaghan v. South Tees Hospitals NHS Foundation Trust (High Court, 19 May 2023 – Ellenbogen J.)

Date published:

Introduction

This case involved the death of a week-old baby, following initial discharge from hospital, from Group B Streptococcus bacterial meningitis and septicaemia.  Allegations centred on the midwifery care.  The judgment is lengthy, amounting to 131 paragraphs and 53 pages, so this report is necessarily a brief summary of a complex ruling.

Detail

Anna was the mother of Imogen, who was born at 16.54 on 26 May 2014 at the trust’s James Cook University Hospital, Middlesbrough.  The main allegations of negligence were: repeated failure to undertake and record proper observations, including the quantity of formula taken; discharge at 14.35 on 28 May was too early; and inadequate advice for the immediate post-discharge period.

In essence, it was asserted that with appropriate care, Imogen would have been kept in hospital for a further day.  Appropriate observations during the late afternoon of 28 May would have revealed signs of sepsis, which would have led to paediatric review.  That would have identified sepsis which in turn would have resulted in urgent intravenous antibiotic treatment and Imogen would have survived her illness, notwithstanding that meningitis had commenced around 17.20 that day, when sepsis crossed the blood-brain barrier.  Importantly, it was not alleged that sepsis should have been identified prior to discharge at 14.35.

The trust argued that full and proper observations had been undertaken throughout, and that Imogen had taken feed appropriately, although it accepted that not all these events had been fully documented.  However, in the absence of any known risk factors there was no need to perform further observations or to commence a regular feeding plan.  No medical or parental concerns had been raised and there were no clinical indicators to keep the child in hospital.

The court heard oral evidence from both factual and expert witnesses.  However, the respective paediatric infectious disease experts were not called because they agreed that prior to her discharge, Imogen had not demonstrated any signs of sepsis.  They opined that feeding problems would not on their own raise concerns of sepsis unless accompanied by other clinical signs.

There was a significant dispute between the midwifery experts as to the standard of care provided.  The claimant’s expert maintained that there was no record of feeding after 19.00 on 27 May and that poor feeding was a clinical indicator of infection, which should have resulted in documented observations.  The trust’s expert accepted that poor feeding might be an indication of illness, but Imogen had been born healthy and was a baby with no known risk factors.

Findings

Mrs. Justice Ellenbogen noted that there were no guidelines indicating the quantities of, or intervals between, feeds for neonates.  She accepted the trust’s evidence that Imogen had taken feed throughout her stay in hospital, some of these events having been recorded retrospectively.  Imogen had not presented in any way to give cause for concern to clinicians prior to her discharge.  Consequently, the discharge was not negligent.

As to advice given to mother prior to discharge, this should have included a recommendation that demand feeding ought to take place every three to four hours.  However, that had no causative impact on Imogen’s death.  Other than this, the advice was appropriate.

The claimant had failed to establish that, in the absence of this one breach of duty, she would have returned to hospital by 21.30 on 28 May which was the latest time, as agreed by the paediatric experts, she would have needed to do so to enable Imogen’s life to have been saved.

Comment

This was a case where the clinical records were somewhat lacking, but the judge was nevertheless satisfied from the evidence of staff in attendance that appropriate feeding had occurred and that the baby had not demonstrated any concerning signs prior to discharge.  The one minor breach of duty was not causatively relevant to the tragic sequence of events which subsequently unfolded.

Unusually for a case involving sepsis, it was not alleged that markers of this condition were missed by clinical staff.  Rather, because of the agreement reached by experts as to timing of clinical signs, the claimant had to rely upon premature discharge as her main argument.

The claimant is seeking permission from the Court of Appeal to challenge this ruling.  At the time of writing, that court’s decision on whether to hear an appeal had not been given.