Adrian was born on the 19 April 1987 at Guy’s Hospital. On the 22 April at about 15:00 hours, his mother found blood, mucus and grainy material in his nappy.
By this time, Adrian was off his feeds, and was drowsy and unresponsive. A midwife attended at home and advised that he should be taken immediately to the casualty department to see a paediatrician.
Adrian arrived at the A&E Department at 17:05 hours. The admitting nurse noted a high temperature and recorded his complaints as “drowsy, blood in stools”.
No clinician saw Adrian between 17:05 and 19:00 hours. When he was seen by a doctor, his mother showed the doctor the nappy containing the blood stained stools.
The doctor did not heed the mother’s history of blood stained stools and threw the nappy in the bin. He made a diagnosis of urinary tract infection and Adrian was admitted to hospital for observation and treatment with antibiotics.
Adrian continued to vomit and was very poorly. His parents spent a very anxious three hours with him in casualty.
Eventually, Adrian was admitted to a ward at 22:15 hours. Shortly afterwards, he began to vomit bilious material, but was not seen by a doctor until about 03:00 hours.
Adrian was immediately referred for a surgical opinion and a laparotomy was performed at about 06:00 hours. The surgeons found a volvulus (a twisting of the bowel). This had caused necrosis to most of Adrian's small bowel.
As a result in the delay in treatment, Adrian suffered a severe long-term injury to his gastrointestinal tract. He has been to theatre over 75 times and spent the first four years of his life as an inpatient in hospital.
Adrian has suffered recurring infections and is still unable to feed normally. He is fed by a tube every night for 12 hours. As a consequence, he has failed to thrive and remains on a barrage of powerful drugs, including steroids and antibiotics.
As a result, he has permanent loss of high frequency hearing and his education has been constantly interrupted with admissions to hospital.
The action was fixed for trial for 29 November 2004. The principle allegations of negligence were that the doctors had failed to give sufficient weight to the history given by the mother and failed to investigate for the presence of blood in the stool and/or failed to refer Adrian to a paediatric surgeon in time.
Liability was difficult. The hospital denied responsibility on the grounds that the stool was normal and that in any event the development of volvulus may occur rapidly.
It was asserted by the defendant that Adrian had no obvious features of volvulus and that it was appropriate to treat conservatively until about 02:00 hours.
The defendant argued that treatment at that stage would not have made any difference to the outcome. The defendants also argued if an abdominal x-ray had been performed early in the evening (as contended by us) it would not have been diagnostic.
Assessing the value of the claim was also difficult because the defendant also stated that Adrian would soon be able to feed by mouth and would soon be able to lead a normal life.
The day before trial the defendant offered to settle the claim in the sum of £1 million. This offer was accepted by the claimant and approved by the court taking into account the undoubted risks of litigation.
The case was conducted by Paul McNeil with the benefit of Public Funding.
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