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Insight

Iona Meeres-Young highlights the emotional impact of an early and full apology from a hospital trust in a medical negligence case

In August, 2011, a baby known in legal proceedings as MxB (shortened here to 'M') was born at King's Mill Hospital in Nottinghamshire, part of the Sherwood Forest Hospitals NHS Trust.

Catastrophic delays by medical staff in delivering her when she was clearly in acute distress caused her to suffer a severe brain injury resulting in dyskinetic cerebral palsy (CP) affecting all four of her limbs.

M is now 8 years-old and lives with her mother, father, brother and half-sister. According to her mother, M is 'loving friendly, bright, cheeky, funny and bossy and extremely affectionate… she adores her brother and sister… and is very fond of our pets. We are a very close family.'

M has very extensive care needs, mostly provided by her mother, which for many years included managing a gastrostomy inserted when she was 8 months-old, which had to be continually monitored and kept clean to feed M. The gastrostomy has been removed and M is beginning to be able to manage food orally, which has made a big difference to the whole family, although there is the additional risk of her choking.

M can walk short distances unaided, but the CP restricts her gross and fine motor skills, causing poor balance and coordination, meaning she falls over regularly. She always has a wheelchair on standby but dislikes using it, preferring to move independently. She suffers chronic fatigue and when she is tired, her behaviour deteriorates, often resulting in tantrums which are physical and potentially put her and others at risk.

She likes to try and dress herself and can manage her buttons.  She is able to sequence her clothes and put on socks and shoes. She also wears a lycrasuit every day to help her coordination, although her mother worries that contributes to M's extreme tiredness.

M attends her local school part-time, with 1 to 1 support. She is developing her use of ICT and other equipment, such as specially adapted scissors, but her speech is severely impaired, meaning she has difficulty with making herself understood, particularly to less familiar listeners.  She slurs when she talks. She dribbles a lot. It gets much worse when she is tired. 

M requires constant supervision to ensure that she is safe. Her mother worries constantly that she is over-friendly with strangers and doesn't understand she mustn't get too close to people she does not know and that must stay close by in the park, for example. It is difficult to get M to retain this type of information.

M sleeps well at night but her parents are constantly on high alert to the gurgles and sounds she makes in her sleep. They lie awake constantly checking on her.

For anyone with little or no experience of living with a child with cerebral palsy, the list of M's 24-hour needs are daunting beyond belief. For M and her family, it's their daily reality.

They and their extended family accept and adore M for who she is, but understandably, the strain impacts their relationships and family life and they worry about her future. Any free time is generally taken up with the admin needed to put in place M's care and education needs.

In 2012, on M's behalf, her mother began a negligence claim, which was settled and approved in 2020 and interim payments were made on M's behalf. A case manager and specialist therapists will now be provided for her entire life, she will have the financial means to be looked after so her life is as safe, easy and enjoyable as it can be and so that her siblings can be her siblings, rather than her carers.

A positive aspect of this tragic case was that the hospital trust admitted liability early, meaning legal procedures could be agreed fairly smoothly, allowing us to investigate quantum costs of care and support as quickly as possible. The family has, for example, moved into rented accommodation with large areas of outdoor space and room for therapies and carers to come to the home.

Associated with this early admission of its liability, in 2013, the family received a letter of apology from the trust that is worth highlighting since it is rare in its sincerity and honesty.

The Chief Executive of the trust fully admitted there were many missed opportunities to identify that M was in distress, with 'heart-breaking' consequences and that they let the family down. He ends by offering his 'truly sincere apology to you and your family and to M'. At the end of the court approval hearing, the trust formally apologised in court and read out the same letter of apology to the family.

The effect on M's family of this transparency and full acceptance of guilt is profound. It's impossible to calculate the stress and misery caused to other families involved in negligence claims when hospital trusts withhold information, refuse or fail to communicate with the family and will not accept their responsibility for the injury of a beloved child – prolonging legal proceedings, unnecessarily, for years.

As the trust admits in the letter, it 'cannot turn the clock back', but acknowledging the seriousness of what happened plus the promise to put measures in place so  prevent a recurrence go some way to relieving the inevitable distress of being forced to pursue a claim to protect the future of an injured child.

Any small burden that can be lifted from the shoulders of parents dedicated to caring for children with cerebral palsy should be embraced and a full and empathetic apology from a hospital trust should be the norm, rather than the exception.

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