Later in the pregnancy, the baby was considered 'large for gestational age' and the mother was referred for a further assessment where polyhydramnios (excess amniotic fluid) was noted. Further tests and scans including a glucose tolerance test (GTT) did not cause concern.
Close to her due date, the mother began to feel unwell and, on attending the assessment unit, underwent a further scan and CTG trace to check the fetal heat rate. Fetal movements were not seen on the ultrasound scan and the CTG trace picked up a sudden deceleration in the fetal heart rate (bradycardia). Following review, it was decided to deliver by emergency caesarean section, but there were various contradictory and amended timings detailed in the records, and an unexplained delay in reaching that decision to deliver.
The baby was eventually born in poor condition with a distended abdomen. She required resuscitation and went on to develop hypoxic ischaemic encephalopathy and brain damage. She also required transfer to Alder Hey Children's Hospital for abdominal surgery. She was intubated by the Countess of Chester team in preparation for transfer, but this caused her condition to de-stabilise, which needed correction by the Transfer team when they arrived. Surgery confirmed the presence of a distended distal small bowel and meconium ileus, which was corrected by the Alder Hey team and stomas formed. She was subsequently diagnosed with a congenital lung condition.
MRI scanning confirmed brain damage consistent with a progressive and escalating hypoxic ischaemic insult that led to increasing brain damage up to the point of restoration of cerebral circulation following birth. The child has severe spastic quadriplegic cerebral palsy, global developmental delay, epilepsy, visual impairment and is gastrostomy fed. This is in addition to the underlying lung condition with chest infections.
The allegations of medical negligence were complex. Expert evidence criticised the failure to identify evidence of an echogenic bowel on the anomaly scan that should have led to referral to a specialist in fetal medicine. This would have led to further scanning, amniocentesis to exclude chromosome abnormalities and screening for her lung condition. This in turn would have led to the baby being diagnosed with her congenital lung condition. The pregnancy would then have continued with heightened surveillance.
On identifying the presence of polyhydramnios later in the pregnancy, the Countess of Chester Hospital NHS Foundation Trust's own guidelines indicated further scanning and tests should be carried out. Had this been done, evidence of bowel dilatation and/or meconium ileus would have been identified by 36/37 weeks gestation and a decision to induce at 38/39 weeks gestation, thereby avoiding the hypoxic ischaemic brain damage.
In addition, when the CTG became abnormal on attending the assessment unit there should have been urgent transfer and delivery sooner than in fact transpired by between 20 to 26 minutes. This additional period materially contributed to the baby's brain damage.
Finally, post-natally, intubation should not have been attempted by the Countess of Chester neonatal staff given the risks of being unable to ventilate the baby properly, who was in any event stable on CPAP such that intubation and ventilation were not urgently indicated. This further period of marked metabolic acidosis materially contributed to his brain damage.
The Defendant denied all allegations of clinical negligence in their entirety. Discussions to resolve the liability issues took place in a settlement meeting prior to trial and settlement achieved on the basis that the claimant received 72.5% of the value of the claim.
Jenny Urwin secured interim payments that allowed the family to move to more appropriate accommodation and to put in place much needed care, case management and therapies (physiotherapy, occupational therapy, speech and language therapy and assistive technology) while the claim for compensation was appropriately valued.
This required an assessment of the impact of the child's genetic lung condition as well as her brain damage. Unfortunately, both conditions adversely affect life expectancy significantly. The child has severe spastic quadriplegic cerebral palsy, global developmental delay, epilepsy, visual impairment and is gastrostomy fed. She needs 24-hour care, with two experienced carers and waking night care to manage her complex condition. She will always be dependent, doubly incontinent, reliant on a wheelchair for mobility, lack capacity for financial and litigation purposes and be unable to work.
Ultimately, the medical negligence claim settled shortly before trial on quantum. The settlement was made up of a lump sum and periodical payments for care and case management equating to an overall settlement of just over £8.5m on the agreed 72.5% basis (or equal to £11.8m on a 100% basis), and which took into account reduced life expectancy.
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