We were instructed by Mrs H, of Maidstone, to investigate a claim in clinical negligence, following the death of her husband J at Maidstone Hospital in January 2015.
Normally a fit and healthy man, J, aged 72, rose one Sunday feeling extremely unwell. He vomited copiously and an ambulance was called. A gastric virus was suspected and he was given paracetamol.
He was no better the next morning. He remained unable to keep solids or fluids down and his vomit was “coffee ground”. The ambulance re-attended and he was taken to Pembury Hospital for further treatment and assessment.
There, the treatment afforded to J was woefully substandard. Observations and bloods taken upon admission were not repeated. No fluid balance chart was started. The junior doctor who saw him fixated on a diagnosis of GI bleeding but failed to consider differential diagnoses including a bowel obstruction with surgical referral. Having commissioned a Glasgow Blatchford score, the result was not calculated nor acted upon. Discharge was ordered without J being seen again by the doctor.
Back at home he remained extremely poorly and his GP made a home visit to him during the early afternoon. She was very concerned about his condition, which she considered to be potentially life-threatening, and phoned both the Maidstone Hospital admissions doctor and the Ambulance Service seeking to arrange an emergency admission by blue light ambulance.
J was taken, by ambulance, to Maidstone Hospital, but not as an emergency. There was then a complete failure by both Trusts to process him on an emergency basis or, indeed, to admit him at all. The hospital had not made prior arrangements for his admission. Somehow the GP’s referral letter was lost. There was a failure to appreciate the urgency to the situation. Instead of undergoing an emergency admission for further assessment, and treatment, J was left on a hospital trolley under the care of ambulance technicians who failed to properly assess him. A dysfunctional relationship appears to have endured between hospital staff and ambulance staff. The upshot was that there was a delay of more than 3 hours before J was finally admitted. Once he was, his observations were highly abnormal with hypotension, tachycardia, hypoxia and blood gases showing his lactate elevated at 8.6. There were further failings then that evening but they would not have made any difference. The delay in admission meant that it was already too late for J.
He suffered sepsis, likely secondary to a pseudo-bowel obstruction, with his condition worsening during the evening and night. A cardiac arrest followed and he died in the early hours of the following morning.
Before instructing us, Mrs H, with the assistance of a good friend, persuaded the Coroner to hold an Inquest, during the hearing of which what happened in the case was explored in great detail.
We relied upon this, extensively, in sending both Trusts a detailed Letter of Claim in March 2018. We alleged negligence on the part of the Maidstone Trust, during the morning, at Pembury Hospital, and negligence by both Trusts during the afternoon, at Maidstone Hospital.
We argued that, but for that negligence, J would have survived.
Further evidence was commissioned from an Intensivist who supported our case on causation.
The Maidstone Trust wrote a Letter of Response in August 2018 making no fewer than 20 admissions of liability. They also admitted that the negligence caused J’s death, whilst arguing that he would not have made a full recovery, notwithstanding the negligence. It was our expert’s contention that he would, indeed, have made a full recovery, and we wrote back to the Maidstone Trust, through the NHS R, in that regard.
The Ambulance Trust wrote a separate Letter of Response, through the NHS R, also in August 2018, the content of which was difficult to decipher in that, firstly, they made multiple admissions of liability then, secondly, seemed to rely on these admissions to argue that causation was not made out in the case. Again a firm rebuttal letter had to be sent.
Initially a settlement offer was made by the NHS R in the sum of £15,000.
Ultimately, however, after a good deal of negotiation, the case was settled in the sum of £60,000.
Nick Fairweather who had conduct of this matter, commented as follows:
“This was a truly tragic case where one set of errors was compounded by further mistakes not just by the same Trust, in a different hospital, but also by the Ambulance Service. Undoubtedly Maidstone Hospital was busy that afternoon but that did not excuse the failure to admit J who was the only patient not processed. But for the manifold failings in the case J and our client would be enjoying the long retirement together that they worked so hard for all their lives. As ever, one can only hope that lessons have truly been learned so that no other family has to suffer like this in the future”.