Substantial recovery after a communication breakdown during tonsillectomy triggers a sickle cell crisis, ending in the death of a young girl at Lewisham Hospital
The complicating factor in the operation was that Jessica suffered with Sickle Cell Disease; SCD is in its simplest terms a disease that destroys the red cells in blood so that when you get a sickling episode the blood flow is blocked and the patient becomes acutely anaemic, and untreated will die. It is well recognised in the medical profession that a) there is a modest risk of bleeding after a tonsillectomy and b) that factor combined with the risk of the surgery creates a risk of triggering a sickle cell crisis (haemolysis). Therefore you need to prepare for the surgery with blood transfusions. However transfusions can also trigger a sickle cell crisis.
In short she had two transfusions in preparation for the surgery, and after the second one the haematologist with overview of the case told the treating clinicians that there were indications of haemolysis and what to do to monitor and manage it. That communication was sent in an email and it was not acted on. The second transfusion took place and then Jessica had the tonsillectomy. It triggered a sickle cell crisis and her mother took her back to Lewisham hospital for review. She was admitted but it took another 48 hours to realise that she was in crisis, and to deliver the correct treatment. It was tragically too late by then and Jessica suffered a cardiac failure in front of her parents, and whilst she was resuscitated, her condition continued to decline rapidly until she died in the early hours of the next day.
In this tragic case there were failures throughout Jessica‘s care in the lead up to the tonsillectomy and her collapse afterwards to recognise that her red cells were falling rapidly, and that the transfusion and then the surgery had triggered a sickle cell crisis.
Mosun had made a complaint and was eventually given a serious incident report that stated that though there had been miscommunication, Jessica’s death could not have been avoided. She took that report to two well-regarded clinical negligence practices, both of which declined to accept instructions. Caron was approached by a friend of the family to give another opinion and on reviewing the report and based on her past experience of running cases involving Sickle Cell disease, decided to take it on. She obtained a report from a Paediatric Haematologist who was forthright in his view that the care was substandard and that Jessica’s death was avoidable and so we put those allegations to the Defendant. The defendant partially accepted the claim, though it did not accept that Jessica’s parents had a secondary victim claim arising out of witnessing Jessica’s sudden collapse and death within 24 hours. The case was litigated and settled after service of lay witness evidence.
Jessica’s family went on to say:
“We could not have done it without you; getting an admission that the Hospital caused Jessica’s death was so important to us.”
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