A thirteen-year-old girl died from Sepsis in hospital after several key opportunities were missed to save her life.
Chloe, 13 from Leicestershire died after being taken to the emergency department of Kettering General Hospital in Northamptonshire on Nov 28 2022 with “severe” pain in her ribs.
According to reports, she had been suffering with a cough and other mild cold-like symptoms in the few days prior to her death, but the illness “didn’t interrupt her usual activities”, Louise Longster, Chloe’s mother, said.
However, when she was there, NHS staff failed to recognise the signs that she was suffering from sepsis, and died hours later.
In hospital, her condition deteriorated and she was later transferred from the paediatric ward, Skylark, to the intensive care unit (ICU), where she was intubated but died the following morning after about 30 minutes of CPR while she was in cardiac arrest.
Speaking before the five-day inquest began, Ms Longster told the PA news agency she felt “powerless” in the 18-and-a-half hours Chloe was in hospital.
Chloe’s mother told the inquest at Northampton Coroner’s Court on the first day of evidence:
“Chloe asked me on Skylark if she was going to die. It’s haunting that the 13 year-old was the one that was right. It’s devastating.”
Her chest x-ray showed “consolidation” to the lower left lung, where there is solid material rather than air, which made doctors initially believe that she had a chest infection or pneumonia.
Rachel Young, the family’s solicitor, made submissions to the coroner, including that a “sequence of delays” and “crucial and significant missed opportunities” were present in Chloe’s care.
She added: “The evidence is clear – a sepsis screening did not happen when it should have taken place.”
In a narrative verdict read to the court, Sophie Lomas, the assistant coroner, said:
“Between 00.15 and 00.40 there were signs of septic shock. Recognition of that should have prompted immediate action.
“There were several missed opportunities to recognise Chloe’s deteriorating condition. The trust recognised those missed opportunities, they have stated there were shortcomings in care both medically and in nursing.
“I do accept on balance that Chloe’s condition, if identified earlier, could have been managed and would have altered the outcome.
“Her death was contributed to by neglect. There were repeated missed opportunities to recognise and respond to her deteriorating condition.”
Chloe’s blood pressure was recorded for the first time on the system nearly eight hours after she arrived at the hospital.
Ms. Lomas said that had the blood pressure been recorded earlier, her Paediatric Early Warning Score (PEWS) would have triggered a red flag for sepsis.
A nurse who later recorded observations did not start the sepsis screening tool and could not articulate why she did not, but agreed that she should have done, Ms. Lomas told the inquest.
In a pen portrait from Chloe’s family, which was read to the inquest, they said she was an “exceptional human being” who was “born to a family that loved her so very deeply”.
The statement, read by Ms. Lomas, said:
“She was a shining example to others with a heart of gold. She saw the world through a lens of kindness. If only the world could have been kinder back. If only in her time of need she was shown the same compassion.”
Ms. Longster said Chloe enjoyed dancing and doing gymnastics, was “very healthy” aside from having mild asthma, and had never been admitted to hospital before.
Following the conclusion of the inquest on Friday, Ms. Longster said in a statement:
“While nothing can make up for the loss of Chloe, we are pleased with the coroner’s findings of neglect as part of her narrative conclusion. There was a catalogue of missed opportunities in Chloe’s care.”
Julie Hogg, the group chief nurse for the University Hospitals of Northamptonshire, said:
“We offer our deepest condolences to Chloe’s family for their loss. We are sorry that we failed to offer Chloe the care she deserved – we should have done more.
“In the two years since Chloe died our teams have worked hard to make significant improvements, including our management of patients with sepsis and those who are not getting better.
“We have also increased our staffing levels and improved the way we communicate with our patients and their families. We realise there is still more to do but we are committed to ensuring that every patient receives the best care.”
Ms. Lomas concluded the inquest by addressing the family and said: “Chloe’s loss is tragic. You, through the pen portrait, presented a picture of a wonderful child who had so much to give. I pass on my condolences in respect of that.”
Medical Negligence – Delay in medical diagnosis
If yourself or a loved one has suffered as a result of medical negligence, you may be entitled to claim compensation.
What is delay in medical diagnosis?
This is when a medical professional fails to a diagnosis a health condition when they should have done or fails to refer you for investigations, meaning you are diagnosed late. This can again lead to a worsening of the condition and prolong your recovery period without necessary treatment.
This can encompass delays in referrals, scans and other investigations. It can also include medical professionals overlooking symptoms or records that are re-reviewed at a later date and urgently acted upon once the delay has been identified. Sadly, in some cases, it can result in the loss of life.
Where might misdiagnosis and delay occur?
Medical misdiagnosis and/or delay can occur in all areas of medical practice. However, are very common in the following settings:
Furthermore, medical misdiagnosis and/or delay can occur in diagnosing any medical conditions however are very common in the following medical conditions:
Medical misdiagnosis and/or delay can severely affect an individual’s life, treatment options, recovery period and in more serious cases the chance of survival.
If you have been given the wrong medical advice or course of treatment which has left you in a debilitating condition, you may be eligible to make a medical misdiagnosis and/or delay claim.
How to make a claim?
If you feel that you have been affected as a result of late diagnosis or incorrect or inappropriate treatment, then you may be entitled to bring about a claim for compensation.
The team at Oakwood Solicitors Ltd will be able to give you free advice on the prospects of your case and whether you would be eligible to make a claim.
Who can bring about a claim?
The patient who has been affected may be able to bring about a claim. However, it can also sadly be the case that the patient has passed as a result of the disease. In such instances, the executor of the estate or the next of kin/dependents may be able to bring about a claim.
Our specialist team will be able to discuss whether you have a right to bring about a claim, so if you or a loved one has been affected do not hesitate to contact us.
How is my case funded?
The majority of clinical negligence cases are funded by a Conditional Fee Agreement (CFA), more commonly known as a ‘no-win, no-fee’ agreement. This means that there will be nothing to pay upfront and nothing to pay if the claim has been lost.
If you are successful in your claim, a deduction of 25% of damages will be taken to cover the success fee and the shortfall in legal fees.
It may also be the case that an After The Event (ATE) insurance policy will be obtained to cover the costs of expensive medical reports and investigations. If an ATE insurance policy has to be obtained the cost of the same will be discussed with you at the appropriate point.
The cost of the ATE insurance policy is again taken from your damages and only payable if you are successful with your claim.
Why should I use Oakwood Solicitors Ltd?
We have a dedicated team of solicitors and paralegals who have many years’ experience between them in running cases of this nature. They are highly trained to deal with all aspects of clinical and medical negligence.
Oakwood Solicitors Ltd wishes to ensure that clients are not overwhelmed by legal jargon or medical terms that they don’t understand and aims to allow the claims procedure to be as transparent as possible.
Further reading
Hospital negligence – Oakwood Solicitors
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Jade Glover is a Solicitor in the Medical Negligence team. She has worked for the company for over 9 years and completed her training during that time. She has specialised in Personal Injury clai…
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