A 13-month-old baby, “Alex”*, became critically unwell with Group A Streptococcal sepsis. Alex’s parent called NHS 111 and described textbook red flags – a high temperature with freezing cold feet, mottled and discoloured skin, a partially non-blanching rash, and a child too drowsy to respond normally. The out-of-hours clinician did not arrange an emergency admission. Alex was sent home falsely reassured and was not treated for a further 20 hours. By then Alex was in septic shock. Alex lost their left foot and part of a finger and sustained a brain injury affecting speech, learning and sensory processing.
We secured an admission of negligence before proceedings were even issued, a court-approved judgement for 87.5% of the full value of the claim, and interim payments totalling £2.65 million, which have already funded prosthetics, a full private therapy team, specialist education support and an adapted family home, years before the claim reaches its final value.
* Not their real name. The court has made an order protecting our client’s anonymity and identifying details have been withheld or changed throughout.
What happened
Alex was a happy, typically developing 13-month-old who was meeting every milestone. Over a few days became unwell with what turned out to be an invasive Group A Streptococcal infection.
On a Sunday lunchtime, Alex’s parent called the local NHS 111 service and was put through to a clinician at an urgent care centre. The parent described, clearly and in detail:
- a fever of 38°C that would not come down despite medication
- a body that was burning up while the legs were cold and the feet were freezing
- purple discolouration of the extremities
- a pin-prick red rash on the neck, chest, back and under the arms, described as partly non-blanching
- a baby who was not responding normally – drifting off to sleep, waking crying, not looking at or engaging with their parent
- barely feeding, and nappies far drier than usual
Every one of those is a recognised red flag for sepsis in a young child. Taken together in a 13-month-old, they called for an immediate 999 ambulance and emergency hospital assessment.
That did not happen. Instead, the family were offered an appointment at the urgent care centre a few hours later. When Alex was seen that afternoon by a different GP, the diagnosis recorded was a viral upper respiratory tract infection. Alex was sent home and the parents were reassured.
After a torrid night, Alex was taken to the GP surgery the following morning. This time sepsis was recognised immediately. Alex went to hospital by blue-light ambulance in extremis — racing heart rate, abnormal breathing, an unrecordable blood pressure. Alex was intubated, ventilated and transferred to a paediatric intensive care unit, where the diagnosis was overwhelming sepsis caused by Group A Streptococcus.
The consequences
Sepsis kills by shutting down blood flow to the limbs in order to protect the vital organs. Alex survived, but at a cost:
- amputation of the left foot (a Syme’s amputation), with the loss of most of the muscle in the lower leg and a blood supply that remains compromised
- amputation of the tip of the left middle finger, with contractures and tethered tendons that have already required further surgery
- extensive scarring and skin grafting to the leg, forearm, hand and scalp, with more surgery anticipated as Alex grows
- acute kidney injury, pleural effusions and pneumonia during the acute illness
- a cerebellar brain injury producing global developmental delay, severe expressive and receptive language disorder, impaired verbal comprehension and memory, sensory processing difficulties, and daily dissociative episodes
The brain injury, not the amputation, is the greater barrier to Alex’s education and independence. Alex needs full-time one-to-one support in the classroom, and requires supervision far beyond that expected of a child of the same age.
How we proved the claim
Establishing the negligence. We served a detailed Letter of Claim setting out precisely what the parent had reported to NHS 111 and why it demanded an emergency referral. The defendant admitted breach of duty before proceedings were issued, admitting a failure to take account of a high core temperature with cold peripheries in a young child, a failure to record it, a failure to warn the parents that this might be very serious, and a failure to arrange urgent assessment. That admission allowed us to release the other parties from the claim and focus our resources on a single defendant.
Winning the fight on causation. Admitting negligence is not the same as accepting responsibility for the injuries. The defendant argued that “the die was cast” – that Alex would have lost the foot and sustained the brain injury regardless. This is the argument that defeats many sepsis claims, and it is where the case was really won.
We assembled a specialist team spanning paediatric infectious diseases, paediatric intensive care, microbiology, paediatric neurology, paediatric orthopaedic surgery and paediatric plastic surgery. Our intensive care expert’s evidence was decisive: while antibiotics cannot switch off the inflammatory cascade instantly, treatment that afternoon would have caught the infection before the tipping point into decompensated toxic shock, purpura fulminans and limb ischaemia and would have produced a far better outcome.
Resolving liability without a trial. We took the case to mediation to avoid putting the family through a contested trial. Across four rounds of negotiation we moved the defendant to 87.5%, meaning Alex recovers 87.5% of the full value of the claim once it is assessed. The court approved that agreement, together with an anonymity order protecting Alex’s identity for life.
The support we put in place for Alex and the family
Securing liability early made everything else possible:
- Money in the family’s hands within weeks, not years. We obtained a first interim payment on approval and then returned to the defendant and the court repeatedly as needs grew. Interim payments made now total £2.65 million and have been held in a personal injury trust with a professional trustee so that the funds are protected, do not affect means-tested benefits, and can be released without a court application every time a need arises.
- A case manager and a full private therapy team. An immediate needs assessment led to a multidisciplinary team funded entirely from the interim payments: case manager, occupational therapist, speech and language therapist, clinical psychologist, neuropsychologist, physiotherapist and prosthetist, plus a private SEN tutor. NHS and local authority provision for Alex was limited, refused or subject to waiting lists measured in years. The difference has been clear – in the family’s own words, Alex would not be progressing as they are without it.
- Prosthetics that actually work. NHS prostheses were uncomfortable and restricted Alex’s movement. Through a specialist private provider Alex has received six prosthetic limbs as they have grown, plus a silicone limb for use indoors and in water, a back-up limb, and a cosmetic silicone digit for the hand. Physiotherapy taught Alex how to walk, climb stairs and move more fluidly on each new limb.
- Education fought for and funded. The MDT trained Alex’s one-to-one support worker, showed the school how to differentiate the curriculum, introduced visual aids, communication software on an iPad, sensory regulation breaks and emotional regulation tools. When statutory speech and language therapy was withdrawn, the case manager and school SENCo challenged it and secured its partial reinstatement at the EHCP review and we funded the shortfall privately, so Alex’s progress never stalled.
- A home Alex can live in. The family home is inaccessible: steps to every entrance, doors too narrow for a wheelchair, no suitable bathroom, too few bedrooms. Through a property finder, a housing occupational therapist and an architect, the purchase of a suitable detached property was funded, planning consent for the adaptations obtained, a competitive five-way tender ran, and the winning contractor’s price was negotiated down significantly. The works are now in progress.
- Recognition for the family’s own losses. The court approved payments to Alex’s parents for the devoted care they have provided. We have also pursued the parent’s cost of purchasing additional annual leave to care for Alex, vehicle changes, childcare that would never have been needed, and the travel costs of years of hospital appointments.
How we kept the pressure off the family
Our approach was built around removing as much of the burden as possible:
- One point of contact. A partner-led team with a named solicitor the family could call at any time.
- No financial risk. The claim was funded so the family never paid a penny towards legal costs.
- We ran the litigation; the case manager ran the rehabilitation. The family were supported by the case manager to project-manage their child’s rehabilitation.
- We took the time the case needed. Rather than settling early, we agreed a split trial – liability now, value later – so that Alex’s brain injury and growth-related orthopaedic risks can be properly assessed as they get older. Neurological reassessment is planned at age 9 and again in the teenage years.
- Court-approved anonymity. Alex’s identity is protected permanently.
How the claim delivered justice
For this family, justice meant three things:
- An admission. The clinician admitted the failures in open correspondence, expressed regret and sympathy to Alex and the parents, and confirmed that the case had significantly changed their practice -they now hold a high index of suspicion for unwell children who may have sepsis. Alex’s parents had been made to feel they were worrying over nothing. The admission confirmed, on the record, that they were right.
- Accountability tested in court. Because Alex is a child, nothing could be agreed privately. A High Court judge scrutinised the settlement and approved it as being in Alex’s best interests.
- A future that is funded. Alex will need surgery, prostheses, therapy, equipment, care and support for life. The claim ensures those needs are met by the party responsible for them, not by an over-stretched family or a rationed statutory system.
