Understanding uterine sarcoma and instances of medical negligence

Uterine sarcoma is a rare form of cancer that affects the uterus or its supporting tissues. It is a complicated disease to diagnose, and when not detected early, can have severe consequences.

In certain instances, it has been observed that medical negligence has led to a delayed diagnosis of uterine sarcoma. This article aims to help you understand uterine sarcoma, the importance of early diagnosis, and how medical negligence can occur in this context.

What is uterine sarcoma?

Uterine sarcoma is a malignant condition where cancerous cells form in the muscles of the uterus or other supporting tissues. This disease is different from endometrial cancer, which originates in the inner lining of the uterus. Uterine sarcoma is a rare kind of cancer that forms in the uterine muscles or the tissues that support the uterus.  There are several subtypes of uterine sarcoma and they are categorized based on the specific type of cells affected.  The main types of uterine sarcoma are:

  • Leiomyosarcoma: This is the most common type of uterine sarcoma and it originates in the smooth muscle cells of the uterus. Leiomyosarcomas are often aggressive and tend to spread to other parts of the body.
  • Endometrial Stromal Sarcoma (ESS): ESS develops in the connective tissue (stroma) that supports the endometrium, the lining of the uterus.  This type of sarcoma is less common than leiomyosarcoma and generally has a better prognosis.
  • Undifferentiated sarcoma: This is a rare and aggressive type of uterine sarcoma where the cancer cells do not resemble normal uterine tissue. It is often diagnosed at an advanced stage and can be challenging to treat.
  • Adenosarcoma: Adenosarcoma is a rare form of uterine sarcoma that consists of both malignant (cancerous) and benign (non-cancerous) components.  It typically arises in the lining of the uterus and may have a better prognosis compared to some other uterine sarcomas.

Uterine sarcoma is distinct from the more common uterine cancers, such as endometrial cancer, which arises from the lining of the uterus.

Risk Factors and Signs

The onset of uterine sarcoma can be influenced by several factors. One of the most significant risk factors includes past treatment with radiation therapy to the pelvis. Furthermore, it has been noted that the use of tamoxifen for breast cancer treatment can also increase the risk of developing uterine sarcoma. A rapidly growing uterine fibroid in a peri-menopausal or postmenopausal woman should raise suspicion of sarcoma.

Patients with uterine sarcoma may experience:

  • Abnormal vaginal bleeding, especially postmenopausal or irregular bleeding between periods.
  • Pelvic pain or discomfort: persistent pelvic pain or discomfort may occur, although it is a nonspecific symptom and can be caused by various conditions.
  • A feeling of fullness or pressure in the pelvic area: this can occur due to the presence of a tumour affecting the uterus or surrounding tissues.
  • Abdominal or pelvic mass: uterine sarcomas can cause the uterus to become larger than usual, leading to a noticeable abdominal or pelvic mass.
  • Changes in bowel or bladder habits: in some cases, uterine sarcoma can cause changes in bowel or bladder habits, such as constipation or increased frequency of urination if the tumour presses against nearby organs.
  • Painful intercourse
  • Backache or leg swelling: in some cases, uterine sarcoma may spread to nearby tissues and organs, causing symptoms such as back pain or leg swelling.

These signs and symptoms, however, can be caused by various other gynecological conditions. Therefore, it is essential to consult a doctor if any such conditions are encountered.

Diagnosis of uterine sarcoma

Diagnosing uterine sarcoma involves several tests and procedures.  A health history check and a general physical and pelvic examination are typically the first steps.

Other diagnostic tests include a pelvic and transvaginal ultrasound exam, followed by pelvic MRI.  An endometrial or transvaginal biopsy can be attempted.  If the results of an endometrial biopsy are not clear, a Dilatation and curettage (D&C), where tissue samples are removed from the inner lining of the uterus is usually done. A hysteroscopy (a procedure used to examine the vagina, uterus, fallopian tubes, and bladder) can also be helpful. However, diagnosis is often reached after a surgical specimen.

Stages of uterine sarcoma

Once a diagnosis is confirmed, the stage of the cancer is determined. The stage of the disease is crucial in determining the treatment plan. The stages of uterine sarcoma are:

  • Stage I: Cancer is found in the uterus only.
  • Stage II: Cancer has spread beyond the uterus but has not spread beyond the pelvis.
  • Stage III: Cancer has spread into tissues in the abdomen.
  • Stage IV: Cancer has spread beyond the pelvis.
Treatment options for uterine sarcoma

Treatment for uterine sarcoma typically involves surgery, chemotherapy, radiation therapy, and hormone therapy. The treatment plan is usually based on the stage of the cancer, the type and size of the tumour, and the patient’s overall health. Patients should consult with a gynaecological oncologist to determine the most appropriate treatment plan for their specific condition.

Medical negligence in uterine sarcoma cases

In certain instances, medical negligence can lead to delayed diagnosis or misdiagnosis of uterine sarcoma. Medical negligence refers to a situation where a healthcare professional provides substandard care, which can lead to harm or injury to the patient.

In the context of uterine sarcoma, medical negligence can involve:

  • Failure to carry out appropriate tests.
  • Misinterpretation of test results – for example, an ultrasound scan or MRI may be reported to show a fibroid, rather than uterine sarcoma.
  • Failure to refer the patient to a specialist.
  • Delay in diagnosis or misdiagnosis.

When medical negligence leads to a delayed diagnosis, the cancer may progress to a more advanced stage, making treatment more challenging and leading to a poorer prognosis.

Legal recourse for medical negligence

Uterine sarcoma is a complex disease that requires prompt and accurate diagnosis for effective treatment. Medical negligence leading to delayed diagnosis can significantly impact the patient’s prognosis and quality of life.

If you believe that you or a loved one has suffered due to medical negligence in the diagnosis or treatment of uterine sarcoma, you may be entitled to make a medical negligence claim. This can help you receive compensation for the physical, emotional, and financial damages you have suffered due to the negligence.

Legal processes can be complex and daunting, so it’s crucial to seek expert legal advice. At Tees, our specialist medical negligence solicitors can guide you through the process, helping you gather the necessary evidence and build a strong case.

Patient safety during maternity care called into question

Tees’ Clinical Negligence team advocates for campaigning for patient safety concerning antenatal, maternity, and neonatal care.

BBC Panorama exposes maternity care failures

A BBC Panorama documentary aired on Monday, 29 January 2024, highlighting maternity care issues at Gloucestershire Hospitals NHS Foundation Trust, including the Cheltenham Birth Centre.

A tragic loss: Margot Frances Bowtell

Tees’ client, Laura Harvey from Gloucester, lost her baby, Margot Frances Bowtell, at just three days old. Laura recalls her experiences with Gloucestershire Hospitals NHS Foundation Trust in 2020 after the hospital admitted liability for failures in her care that led to Margot’s death.

Margot was born on 14 May 2020 at the midwife-run Cheltenham Birth Centre and passed away on 17 May 2020 due to a hypoxic brain injury sustained during delivery.

Investigation and accountability

The care Laura and Margot received was provided by two midwives, who are no longer working at the Trust. Both midwives are now under investigation by the Nursing and Midwifery Council (NMC) regarding the circumstances surrounding Margot’s death.

A report by the Healthcare Safety Investigation Branch (HSIB) identified multiple care issues, including a failure to update Laura’s risk assessment after she experienced reduced fetal movements and a bleed at 34 weeks pregnant. As a result, Laura was admitted to a midwife-led, low-risk ward instead of the consultant-led unit she needed.

Missed opportunities for intervention

During labor, Laura experienced further episodes of bleeding. However, these were not escalated to the on-call obstetricians, nor was the information properly handed over between midwives during the shift change on 14 May 2020. HSIB concluded that a referral to the obstetric-led unit for continuous monitoring of Laura and Margot was necessary.

Gloucestershire Hospitals NHS Foundation Trust admitted liability for failures in Laura’s care that caused Margot’s death.

Legal advocacy and expert commentary

Sarah Stocker, Associate at Tees, stated:

“The midwives involved did not follow both national guidance and the hospital’s own clinical guidance on several occasions during Laura’s labor. If the midwives had acted in the hours before Laura gave birth, she would have been transferred to the appropriate ward for obstetric-led care. With continued monitoring, Margot would have been delivered at the first sign of fetal distress and would still be with us today.”

Laura Harvey’s perspective

Reflecting on the midwives and ongoing investigations, Laura Harvey said:

“As a family, we want and more importantly deserve to know why both midwives made the decisions they did and why they chose to directly ignore and not follow the Trust’s own standard practice procedure. It was not just one point where they failed to escalate my care; it was a series of failures.”

A positive experience after loss

In December 2023, Laura safely delivered a baby daughter at Gloucester Hospital, under the care of the Rainbow Team. This time, she experienced exceptional care.

Calling for safer maternity practices

Laura Harvey continues to advocate for better maternity care, emphasising the importance of following safety procedures:

“There are midwives who are working hard and following the safety procedures in place to bring babies into our world, going above and beyond to help everyone.

It should not be a postcode lottery where you give birth and the care that you receive. Midwives and doctors need to follow the national set of safety procedures.

We need to highlight the Trusts that are excelling and share knowledge with those currently struggling. Most importantly, we need to share and learn from what happened to Margot to prevent it from ever happening again.”

Sepsis medical negligence claims – baby Yousef’s story

Sepsis is a life-threatening condition that can cause organ failure and death. In the UK, there are around 245,000 cases of sepsis every year.

Prompt identification and timely treatment of sepsis is vital to avoid catastrophic outcomes. When sepsis is not recognised, or medical care is delayed, the outcomes for patients can be devastating. Some patients may have to have limbs amputated, whilst others might suffer severe organ damage. And, in the UK alone, nearly 50,000 people lose their lives to sepsis-related complications every year.

Tragically, this is what happened to one-year-old Yousef, who died of sepsis on 5 February 2023.

Baby Yousef was the son of Mohammed Elsiddig and Duaa Siyed Ahmed, both of whom are qualified medics. But despite being doctors themselves, numerous medical professionals failed to listen to Mohammed and Duaa’s repeated and increasingly urgent concerns. Tragically, by the time treatment was started, it was far too late.

What causes sepsis?

Sepsis (also known as septicaemia or blood poisoning) is a life-threatening medical condition that occurs when a person’s immune system overreacts to an infection and begins to attack the body’s tissue and organs. People with weakened immune systems are at higher risk of such infections, and therefore at higher risk of developing sepsis.

It can be triggered by any kind of infection, including colds and flus, infected cuts and chest infections. Sepsis can lead to tissue damage, shock, multiple organ failure, blood clots and – particularly if it is not recognised and treated quickly – death.

Sepsis symptoms

Sepsis presents differently in adults and children, which is why awareness of the symptoms is so vital.

Sepsis symptoms in adults

According to the UK Sepsis Trust, adults who present with sepsis might have some or all the following symptoms:

  • Confusion or slurred speech
  • Extreme shivering or muscle pain
  • Not passing urine
  •  Severe shortness of breath
  •  Feeling extremely ill
  • Mottled or discoloured skin.
Signs of sepsis in children

Babies and children with sepsis might present with some or all of the following symptoms:

  • Fast breathing
  • Fits or convulsions
  • Mottled, blue or pale skin
  • A rash that doesn’t disappear with pressure
  • Lethargy
  • Abnormally low temperature
  • Vomiting
  • Not passing urine.

Yousef’s story – multiple failures to diagnose and treat sepsis

Yousef’s death was a tragedy and could have been avoided with earlier diagnosis and treatment. Throughout his illness, he presented with many, if not all, of the sepsis red flags described above – but the signs were missed time and time again.

Yousef’s illness began with fever and flu symptoms shortly after having his one-year vaccinations. His parents understandably thought that this was a passing viral illness and treated him symptomatically with Ibuprofen and Calpol. When he continued to feel poorly, they took him to his GP, who agreed it was probably viral.

Yousef’s first attendance at A&E

A few days later, Mohammed and Duaa took Yousef to A&E. By this time, his fever had lasted for nearly a week, he was not taking much food or fluid, and he had a cough and was not his usual self. Yousef had also become lethargic, sleeping through the whole night – something that was unusual for him.

Mohammed and Duaa were extremely concerned that Yousef may have sepsis and begged the doctor to do blood tests. The doctor refused, said it was likely resolving flu and sent Yousef away with oral antibiotics.

Yousef’s second attendance at A&E

The next day, Yousef’s fever took a turn for the worse and he was shivering and vomiting. He couldn’t keep his antibiotics down. He had difficulty breathing. His parents called 999 and were told to wait for a callback. They were so worried about Yousef that they instead decided to take him back to A&E.

After being triaged as non-urgent, waiting for five hours and being told they were facing an 18-hour wait for treatment, Mohammed and Duaa decided to take their baby home as his antibiotics were due.

After a short spell of improvement, Yousef’s condition deteriorated. He developed diarrhoea and his urine output significantly decreased. His temperature reached an all-time high. He didn’t want to eat or drink. His breathing became fast and flat. His heart rate was rapid and his skin was mottled.

Emergency 999 call

·       Mohammed called 999 and described Yousef’s symptoms. After listening to his breathing, the ambulance clinician said that she was extremely concerned that Yousef may have sepsis – however, there were no ambulances available for 10 hours. His parents were advised to take Yousef to A&E themselves within the hour.

Yousef’s third attendance at A&E

Despite the phone operator giving them a referral that was supposed to get Yousef seen more quickly, on arrival, Yousef was treated as non-urgent. Terrified that Yousef had sepsis, Mohammed challenged the triage nurse (who had witnessed Yousef vomiting) but he was told, “Just because you think he has sepsis doesn’t mean he has it.”

Yousef was seen by a doctor, but Mohammed and Duaa were told he likely just had a normal fever. The doctor would not listen to them and Mohammed remembers him cutting Duaa off mid-sentence several times. The doctor refused to do blood tests but agreed to observe Yousef overnight. After judging the overnight results as normal, he stopped Yousef’s antibiotics.

Following more pressure from Mohammed and Duaa, he agreed to perform a blood gas test – which does not check for infection – the results of which were said to have come back normal.

The doctor said to Mohammed: “I’m now happy, it’s your turn to be happy.” Mohammed states that he retorted: “How could I be happy when I’m seeing my child poorly in front of your eyes and you’re not doing anything for him?” Mohammed was told he was worrying too much and, when challenged further, the doctor told Mohammed that he was over-worried. The family were, again, sent home, feeling unapologetically dismissed.

Private bloods

By now, Mohammed and Duua were so desperate, that they decided to try to arrange for private blood tests. As a same-day appointment was unavailable, they booked one for the next day.

The private GP was seriously concerned about Yousef’s condition and strongly advised that Yousef be seen by either the NHS GP or a paediatrician. The blood results took several days to process. When they did come back, they clearly showed high levels of infection in Yousef’s blood.

NHS GP Visit

Whilst at the private GP, Yousef’s NHS GP called to follow up on his recent hospital visit. Mohammed told the GP that Yousef’s condition was deteriorating. His temperature was high, his nappies dry, his stools loose, he was refusing to eat and he was interacting less. He was lethargic and irritable.

The GP agreed to see Yousef face to face in the clinic but diagnosed him with hand, foot and mouth disease – despite a rapidly developing skin rash and no symptoms in these areas of his body.

Mohammed and Duaa asked the GP to refer Yousef back to the hospital for further assessment, but the GP refused to refer him. Once again, Mohammed, Duaa and Yousef were sent home. They remember feeling angry and frustrated, and like they were being ‘gaslighted’.

Yousef’s fourth attendance at A&E

Later that day, Yousef’s parents noticed swelling and discolouration around his bottom, which looked like an abscess. They rushed him back to A&E, where their concerns were once again dismissed.

It was only when Yousef began struggling for breath that he was rushed into a side room and put on oxygen. With his parents crying by his side, a consultant finally admitted that Yousef might have sepsis. Mohammed remembers saying, “I don’t want him to die.”

“Everything was too slow,” said Mohammed. “Giving him IV fluids, and antibiotics, you could see he was in severe pain. We begged them many, many times to give him something for the pain, but everything was slow. Everything was delayed.”

Yousef was eventually intubated and admitted to the paediatric intensive care unit (PICU) after suffering a vacant episode. Sadly, following several cardiac arrests – which resulted in a lack of oxygen and brain death – Mohammed and Duaa’s little boy passed away from overwhelming sepsis. He had just turned one.

Seeking justice and raising awareness

With the help of Janine Collier, who heads up the Medical Negligence team here at Tees, Mohammed and Duaa are bringing a sepsis negligence claim against Birmingham Children’s Hospital and are working to raise awareness of sepsis and the importance of listening to parental concerns, to ensure a lasting legacy for Yousef.

They said: “Our son was failed. He had many chances to survive, but they were all missed by healthcare professionals. He suffered so much pain and we still suffer from the trauma and horrible pain of losing our precious baby because of a whole system failure, medical negligence and lack of sepsis awareness.

“More must be done to stop the trauma and horror that we and other families have been through. We are very passionate about making a change – all hospitals should be able to follow Sepsis Trust or NICE guidelines and prevent such dreadful outcomes due to a completely curable and preventable illness.

“Parental concerns and repeated visits to A&E are equally important in recognising sepsis. Only together can we change a broken system and raise awareness about sepsis amongst parents and – most importantly – the professionals who are responsible for caring for us and our children.”

Janine, who is working closely with Mohammed and Duaa on their case, said:

“This is yet another devastating instance of how an overwhelmed health system and a total lack of sepsis awareness, has resulted in an entirely preventable death. At just one-year-old, Yousef has had his whole life snatched away from him, leaving his parents’ world in tatters.”

“Nothing will ever replace Yousef or make up for his death. However, we can work hard to secure justice for him and support Mohammed and Duaa as they in turn do everything they can to prevent this kind of tragedy from ever happening to another family.”

Tees supports grieving family with clinical negligence case

Justice at Stake: A Mother’s Testimony on Legal Representation in Clinical Negligence Cases

A Heartbreaking Loss: Adam Bunn’s Story

The mother of a young man who lost his life in 2021 has spoken out about the invaluable help provided by the Clinical Negligence team at Tees Law during a time of real need.

This case serves as a powerful reminder of the importance of specialist legal representation in supporting families and driving improvements in healthcare standards. This comes as the government’s proposals on Fixed Recoverable Costs (FRC) threaten to significantly limit access to justice for vulnerable groups.

What Happened to Adam Bunn?

In September 2021, 26-year-old Adam Bunn was admitted to the hospital, diagnosed with severe constipation, and discharged a few days later. Tragically, he was back in hospital the following day, where he collapsed and could not be revived.

An inquest in 2023 revealed that Adam had sepsis and rectal faecal impaction. His blood tests showed clear signs of sepsis, which should have been identified.

A Mother’s Perspective: katie Bunn’s testimony

Katie Bunn, Adam’s mother, shares her experience:

“Our son, Adam, died suddenly and unexpectedly on Friday, 17 September 2021. His inquest took place nearly two years later in August 2023. The coroner concluded that the hospital trust failed Adam in six key ways, one of which was due to neglect. With the correct diagnosis and treatment, Adam would likely have survived.”

The role of legal representation in the inquest

Katie Bunn emphasised the essential support provided by Tees Law:

“We were represented on a ‘no win, no fee’ basis by Tees Law, whose experience in clinical negligence cases was invaluable. Without their guidance, I am certain the coroner’s findings would not have been as comprehensive. The Trust would not have admitted their failings without legal pressure.”

She further explained how the legal team selected expert witnesses, engaged a skilled barrister, and navigated the complexities of the coroner’s court.

“The prospect of facing this process without legal support would have been unimaginable.”

The impact of fixed recoverable costs on access to justice

If the proposed FRC rules had been in place during Adam’s case, the family might not have been able to secure legal representation.

“The Trust would still have had taxpayer-funded legal representation, while we, as a grieving family, would have struggled without the necessary support.”

Tees Law’s perspective on fixed recoverable costs

Tees Law’s Clinical Negligence team expressed their concerns:

“Over the last decade, we have built a specialist practice representing vulnerable clients at inquests. The government’s FRC proposals will further marginalize vulnerable groups, including the elderly, those with mental ill health, and individuals with learning disabilities.”

Understanding Fixed Recoverable Costs (FRC)

Fixed Recoverable Costs (FRC) are legal fee limits proposed by the government for certain medical negligence claims. The most significant impact will be on claims under £25,000, which often involve vulnerable individuals.

The Department of Health has acknowledged that the proposed reforms disproportionately affect people with disabilities, the elderly, and low-income groups.

Recent changes to FRC in October 2023

In October 2023, the government implemented FRC for claims valued between £25,001 and £100,000. These reforms introduced an Intermediate Track with case-specific factors and Complexity Bands that determine cost limits.

Conclusion: Ensuring fair access to justice

Adam’s story highlights the essential role of legal representation in holding healthcare providers accountable and securing justice for grieving families. Fixed Recoverable Costs threaten this access to justice. It is crucial to ensure that vulnerable individuals retain the right to adequate legal support.

Tees Law remains committed to fighting for families like Adam’s and advocating for fairer legal frameworks.

Tees Law now boasts six Top Tier practice areas in Legal 500

Tees Law enjoyed widespread success in this year’s Legal 500 directory, adding Private Client – Personal tax, trusts and probate in Essex to the highest Top Tier ranking.

Ian Johnston, Partner and lead of the Private Client team in Tees’ Essex based offices of Chelmsford, Brentwood and Saffron Walden, moved up the rankings becoming a Next Generation Partner. One client commented, “Ian Johnston is a fine example of the ability of the firm to deliver the human approach to what can be very serious discussions.”

The Personal tax, trusts and probate team is described as having an “outstanding reputation for quality” and as being “consummately professional, and yet provide a service which feels warm, friendly and personal. All considerations are covered and delivered in an understandable yet thorough manner.”

In total, 27 different Tees Law practice areas were ranked in the latest update of the world’s leading directory of Law Firms.

Tees Law was delighted to see a total of 8 Leading Individuals, 5 Next Generation Partners and 7 Rising Stars. A staggering 46 of the firm’s solicitors have been listed as Recommended Lawyers with an increase of 16 this year.

Tees Law is a major regional law firm with offices in Bishop’s StortfordCambridgeRoystonSaffron WaldenBrentwood and Chelmsford. As part of the local community for over a century, Tees Law has supported clients from generation to generation.

The recurring theme throughout the client testimonials published this year highlights the firm’s focus on the client’s needs. An Essex Commercial Property client stated, “The team are great to work with. They all put each case in such high regard. All members of the team are professional and hold your best interest as a client highly.

Another client praised “A first class firm with many talented individuals. Their client focus, commerciality and friendliness has been outstanding.”

Group Managing Director at Tees Law, Ashton Hunt, commented: “Once again the success and dedication of our teams and individuals shines through in the Legal 500 rankings. I am delighted to see so many practice areas receiving accolades and to have increased our number of Tier 1 rankings. At Tees, we always strive to be renowned experts and provide personal and commercially tailored advice to our clients.”

Catherine Mowat, Senior Partner at Tees Law, who was this year named in the Hall of Fame, added: “This year’s results highlight the diligence and commitment of our highly skilled teams. It is an honour to be named in the Hall of Fame and I would like to thank all of our clients and referrers for their wonderful feedback.”

Essex Hospital Trust investigation into patient deaths after heart surgery

Mid and South Essex NHS Foundation Trust, which is responsible for Basildon University Hospital, Southend University Hospital and Broomfield Hospital (in Chelmsford), has recently launched an investigation into the deaths of patients following open aortic abdominal aneurysm (AAA) surgery.

This alarming development has raised concerns about patient safety and the quality of care provided by the Hospital Trust.

In this article, we look into the details of the investigation and explain what we can do to help you if you or a loved one has been affected by this issue.

Abdominal Aortic Aneurysm (AAA) Surgery

An AAA is a potentially life-threatening condition in which there is a balloon-like swelling in the aorta, which is the main artery carrying blood from the heart to the abdomen, pelvis and legs. The swelling is caused by weakness and, should the aneurysm grow to more than 5.5cm, surgical intervention may be required to replace weakened sections of the aorta with a plastic tube (graft). While this surgery can be lifesaving, it carries risks and needs a high level of surgical expertise.

Mid and South Essex NHS Foundation Trust Investigation

The Hospital Trust has recently declared an ‘organisational serious incident’ after a higher number of their patients died following AAA surgery than would have been expected. Dr David Walker, chief medical officer at the Hospital Trust, has said that investigations are underway to ensure AAA services being offered to patients there are safe, and that lessons can be learned from post-operative deaths. The Hospital Trust has appointed an external investigator to lead the investigations, which may take in the region of 6 -12 months to complete.

Impact on Patients and Families

The implications extend beyond the Hospital Trust itself, affecting patients and their families who have undergone or are scheduled to have open AAA surgery. The uncertainty surrounding the investigation’s outcome and concerns for patient safety may cause significant distress and anxiety.

It is vital that the Hospital Trust communicates openly and transparently with affected individuals, providing them with support and reassurance throughout the investigation process.

The Hospital Trust will then need to implement any necessary changes identified through the investigation and to rebuild trust and confidence in the care they are offering.

How Tees Can Help

If you or a family member has been affected by the issues raised in this article, you can get in touch with the medical negligence team at Tees who have specialist solicitors with many years of experience.

We have dealt with numerous claims against Mid and South Essex NHS Foundation Trust, including claims relating to cardiac treatment.

If you would like to contact us, we will be able to give you free, confidential initial advice. We can discuss with you whether we can assist you in making a complaint or claim against Mid and South Essex NHS Foundation Trust. We understand that, in addition to ultimately obtaining any financial settlement that you may be entitled to, it is also important to obtain explanations when there have been shortcomings in treatment, and we also appreciate the sensitivity required when the treatment in question has led to the loss of a loved one.

When medical negligence becomes criminal

Medical negligence arises when the treatment provided by a healthcare professional falls below the standard of a responsible body of medical opinion and that substandard care has caused harm or injury.

In some cases, however, a doctor’s actions go so far beyond what is considered acceptable that their behaviour is deemed to be criminal.

Our medical negligence specialists provide expert legal advice for a wide range of medical negligence claims.

If you think the medical treatment that you have received has been negligent or even criminal, Tees can help you to recover compensation for the harm that you have suffered.

Deliberate negligent acts resulting in criminal conviction

In rare cases, doctors treat their patients in ways that go far beyond medical negligence. In these circumstances, their actions can only be treated as a deliberate attack on their patients.

In 1993, Beverley Allitt, known as the “Angel of Death” was given 13 life sentences after being convicted of murdering four children and in 2000, Harold Shipman was found guilty of murdering 15 of his patients and is thought to have had over 200 victims.

A recent example is the case of surgeon Ian Paterson.

What did Ian Paterson Do?

Ian Paterson was convicted of 17 counts of wounding with intent in April 2017 and is currently serving a 20 year prison sentence. Paterson had performed unnecessary surgeries on over 1,000 patients in the Heart of England NHS and private hospitals (Spire Parkway and Spire Little Aston). These procedures included hernia surgeries, varicocele repairs, unnecessary mastectomies leaving his victims feeling violated, mutilated and psychologically traumatised.  He also performed unregulated “cleavage-sparing” mastectomy procedures, leaving breast tissue that often resulted in the return of the cancer and, in some cases, the death of the patients.

In February 2020 a report from an Independent Inquiry was published.

It is estimated that Paterson treated more than 11,000 patients. Of these, more than 750 have so far received compensation for the damage he caused to them in a settlement deal struck in 2017, involving some 40 law firms. However, many more may have been affected by his actions and that they too may be due compensation.

In December 2020, more than 5,000 patients were contacted by Spire Healthcare after independent clinicians reviewed their medical records.  Patients were offered a telephone meeting and follow-up treatment, and Spire Healthcare have set up a new compensation fund for victims of Ian Paterson.  Tees is pleased to help former patients of Mr Paterson who have been recalled by the Spire to claim compensation from the second compensation fund, if they did not apply for compensation from the initial fund for the same injury.

Failing to provide safe care and treatment

In April 2021, East Kent Hospitals NHS Trust pleaded guilty to a criminal charge brought by the Care Quality Commission (the CQC) over failings that led to the death of Harry Richford, at 7 days of age.  Harry was delivered by emergency caesarean section performed too late by a locum,  a second doctor delayed resuscitating Harry and he died from irreversible brain damage.

The CQC charged the Trust with breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which obliges trusts to provide safe care and treatment.

Again in July 2021, The Independent reported that the CQC is considering a criminal prosecution against Nottingham University Hospitals Trust, following the death of baby Wynter Andrews in September 2019. 

When does a lack of consent give rise to a criminal case of battery or assault

If a patient has not given informed consent to a medical procedure both medical negligence and criminal liability may arise.

Informed consent is a relatively complex legal concept, but the over-riding principle is that a patient has the right to be advised of not only the benefits but also the material risks of the proposed treatment and be made aware of any reasonable alternatives (including doing nothing).  Consent issues normally arise in the context of surgery but should be considered when any treatment is offered.

If a patient has not consented to the medical treatment, this could lead to a criminal charge for battery or assault.  This requirement for consent is waived if the patient:

  • is unconscious or incapacitated and needs emergency life-saving treatment
  • needs an additional emergency procedure during an operation
  • lacks capacity to consent to treatment of their mental health due to their mental health condition (but consent is still required for treatment for unrelated physical conditions)
  • has been detained under the Mental health act
  • is a public health risk due to having Rabies, Cholera or TB

Once more, it is the Police and Crown Prosecution Service that determine whether it is appropriate to bring a criminal case against a doctor in these circumstances. Intent to harm is likely to be very relevant and more often than not a civil suit will be more appropriate.

Criminal gross negligence (medical) manslaughter

The crime of gross negligence (medical) manslaughter arises where death occurs as the result of “truly, exceptionally bad” healthcare.

Usually a criminal investigation is triggered by the Coroner referring the case to the Police for investigation, although families can also ask the Police to look at the circumstances of death.   The CPS will consider whether it is in the public interest to prosecute the relevant medical professional including whether they consider that prosecution is a proportionate response. The case will be decided by a Jury, in a criminal court.  To secure a conviction, the Jury must be satisfied, beyond all reasonable doubt, that the individual or Trust committed the crime of gross negligence manslaughter.  A conviction may result in a custodial prison sentence.

How do you prove gross negligence manslaughter?

In 1994, an anaesthetist called Adomako was convicted of gross negligence manslaughter. Adomako hadn’t noticed that a patient’s oxygen pipe had become disconnected during an operation. Consequently, the patient died.

The judge in this case set out the test for gross negligence manslaughter:

  • there must be a duty of care
  • the defendant must have breached that duty of care
  • the breach must have caused the death of the victim and
  • the breach of duty is so serious in all the circumstances that it should be judged criminal

The judge also gave some examples of what might constitute a criminally serious breach:

  • indifference to an obvious risk of injury to health
  • knowing the risk of injury to health at the outset but a determination to run the risk nevertheless
  • knowing the risk of injury to health and intending to avoid it but coupled with such a high degree of negligence in attempting to avoid injury that a jury deems a charge of criminally serious breach as necessary

Gross negligence manslaughter conviction examples

In this final example, the judge stated that: for gross negligence to be found, there must be a “serious and obvious risk of death”, rather than just risk of serious injury. The risk must be “assessed with respect to knowledge at the time of the breach of duty”. 

The line between negligence and gross negligence is therefore still hard to define.

Corporate manslaughter and corporate homicide

The Corporate Manslaughter and Corporate Homicide Act 2007 means that organisations can be found guilty of the office of corporate manslaughter or homicide.

In a medical context, NHS Trusts may face criminal prosecutions if a patient dies as a result of gross negligence.  If found guilty, the healthcare Trust may be fined or ordered to take steps to remedy any deficiencies in health and safety policies, systems or practices.

series of baby deaths at the East Kent Hopsitals University Trust has recently prompted a police investigation into a possible corporate manslaughter and/or gross negligence manslaughter charge relating to unsafe maternity care that has affected nearly 200 families over a number of years. The Health and Social Care Committee on maternity safety in England has now released a report on the Safety of Maternity Services in England. The report concludes that improvements in maternity services have been too slow, with the CQC’s Chief Inspector of Hospitals reporting evidence of a ‘defensive culture’, ‘dysfunctional teams’ and ’safety lessons not learned’.  Sound familiar?  MPS have recommended urgent action to address staffing shortfalls in maternity services with staffing numbers identified as the first and foremost essential building block in providing safe care.

How Tees can help

If you or a close family member have suffered harm from negligent medical treatment, please get in touch. We will investigate what happened, advise you on your potential claim, and support you in bringing a claim.

We know that going through something like this alone can be a daunting and worrisome prospect, but our empathetic and caring team is here to help you secure the best outcome.

How to make a medical negligence claim

Most medical care is safe and effective. However, mistakes and systemic errors will occasionally occur, especially where nurses and doctors are over-stretched. Fortunately, these mistakes and errors rarely cause harm, but if something does go wrong and you have been injured, you should seek the advice of a specialist medical negligence solicitor.

What qualifies as medical negligence?

The fact that there may have been an error or a poor outcome does not automatically entitle you to compensation. However, if you have been injured because a doctor or other healthcare professional has not provided the proper standard of care, it may be possible to claim compensation. You should seek specialist legal advice to help you through this process – it will be almost impossible to navigate alone, without expert help.

We understand that complaining about medical treatment can feel overwhelming and distressing, but there are many good reasons for making a complaint and possibly, in addition, a claim for negligence. For example:

it will help you understand what happened
if you have suffered injury and financial loss, it’s important that you receive the compensation that you need to build your life back up again: to fund any additional treatment, rehabilitation or additional costs and to positively plan for the future
patient safety can be improved when healthcare providers are made aware of what has happened.
In the vast majority of cases, the claim will not be made against an individual such as a doctor or nurse, but rather against their employer.

Here we set out the process:

Making a medical complaint: If you would like a full explanation of what has happened, an apology from the hospital or doctor concerned and assurances that any problems that might affect other patients have been addressed, you could consider:

complaining to the doctor or hospital involved in your care and asking for an explanation
using the formal NHS Complaints procedure to make a formal complaint
contacting the body responsible for improving and monitoring the quality of care. In England, this is the Care Quality Commission, and/or
writing to the professional regulatory organisation, for example, the General Medical Council (for doctors in United Kingdom) or the Nursing and Midwifery Council (for nurses and midwives in England and Wales) if there is a question about an individual doctor or other healthcare professional’s fitness to practice.
For further information, please see the AVMA Guide to Making a Complaint under the NHS Complaints Procedure.

Free assessment: When you get in touch, your case will be assessed – free of charge – by our specialist assessor who is a medical negligence lawyer with over 40 years’ experience. You will get a highly expert opinion and a helpful and responsive service. We will listen to you, understand what you want to achieve and advise you how best to proceed. We will also let you know if we think you do not have a case for compensation.

Will I be eligible for compensation?

A big part of the initial assessment we will do for you, is establishing what happened, and more specifically working out if there is likely to be a case for compensation to be paid. Compensation will only be paid if you can prove all three of the following:

  1. the health professional treating you owed you a duty of care. All healthcare professionals have a duty to their patients to take reasonable care when carrying out their professional skills.
  2. the health professional was negligent. A healthcare professional must provide an acceptable standard of care which is consistent with a responsible body of medical opinion. A healthcare professional is not negligent if other responsible healthcare professionals would have acted in the same way.
  3. And you suffered harm, as a result of the negligence. This is known as causation.

When you come to us, we will listen to you, obtain medical records and work out whether you have a case that has a good chance of being successful.

Examples of medical negligence

There are many different ways in which medical negligence can occur.  Here are some general examples:

  • a failure to diagnose your condition
  • a delay in diagnosing your condition
  • making the wrong diagnosis
  • failing to arrange the investigations or treatment you need
  • failing to warn about the risks of a particular procedure
  • surgical error
  • failing to recognise and act on complications
  • making a mistake in the prescription, administration and dispensing of drugs.

How can I afford to pay legal fees to make a claim?

Please don’t worry about costs. There are options available which mean you don’t have to pay out any money in advance of getting compensation, or at all, if the claim is not successful. There are a range of options, including no win, no fee, which we will explain to you before you start a claim. These include:

  • legal-expenses insurance
  • trade union funding
  • “legal aid”
  • private funding
  • “no win, no fee”.

No win, no fee

Most medical negligence clients choose a “no win, no fee” agreement.  No Win, No Fee arrangement ensures you don’t pay any legal or associated costs unless your case is successful. If you win, most of your legal costs are paid by the Defendant.  A small portion of your compensation may be used to cover legal costs not paid by the Defendant. The majority of our clients choose this option for peace of mind and affordability.

Is there a time limit for making a claim?

In England and Wales, a medical negligence claim must normally be brought within three years of the date of the accident or the date that you became aware that your injury was linked to the original accident (whichever is latest).  This is known as the “date of knowledge”. The date of knowledge can be much later than the accident date.

If legal proceedings are not started in court within the three years, the case is then “time-barred” or “statute barred” as it is sometimes known, which means it cannot proceed.

There are exceptions and special rules apply for children, for adults with serious mental disabilities, for fatal cases and Human Rights Act cases.  The courts do have discretionary power to allow claims which are already outside the time relevant limits to proceed, but these powers are only exercised under very limited circumstances.

Who will handle my case?

We have a large and experienced team of highly regarded specialist lawyers, with decades of experience and expertise in medical negligence cases. One of these lawyers will be your primary contact and will take responsibility for your case. This person will be your individual point of contact.  Unlike many firms, we make sure that at Tees, our lawyers only look after a small number of clients at any one time – we want to be there for you when you need us.  Your lawyer will work closely with you throughout your case to understand your concerns, answer your questions, support you through the harder times and celebrate the good times with you.

Stage 1: Investigating your claim

It’s important to investigate your claim thoroughly to establish how strong it is.  The initial investigations can therefore take several months.

We will then prepare an initial statement based on your recollection of events.

We will then apply for a copy of all your medical records and sort and review these.

Any case that is brought must be supported by independent expert evidence.  Therefore, the next step will be to instruct an independent medical expert to review your records and advise whether or not the care you received fell below an acceptable standard. Tees has contacts with a wide range of medical experts and we only work with those with the highest professional qualifications and reputation.

If your treatment was substandard, we will also need to instruct an independent medical expert to consider whether this caused, materially contributed to, or worsened your condition.

We may in addition, arrange a meeting with an experienced barrister and the medical experts to review the evidence in detail and ensure that your claim is strong enough to proceed.

Stage 2: Starting your case

The next step is to notify the defendant (for example the hospital) in a detailed “letter of claim”.

The defendant has four months to reply with their “letter of response”. This gives them the opportunity to investigate your case.  They may deny that they are responsible for your injuries or they may agree that they are liable for some or all of your injuries.  They may offer you compensation to settle your claim.

After we have received the letter of response, we will review your case further and advise you whether to commence formal court proceedings.

Stage 3: Commencing court proceedings

A claim is issued by sending a simple formal court document, called the claim form, to the court.  This must be served on the defendant within four months of receiving their letter of response, together with:

  • a statement of your claim (the “particulars of claim”), which will set out the allegations of negligence
  • a “schedule of damages”, which will set out the specific financial losses incurred as a result of the alleged negligence and an estimate of the likely future losses
  • a medical report on your condition and prognosis.

You will need to approve all these documents and sign a “statement of truth”, confirming that the documents are true and accurate, before we send them to the defendant.

Stage 4: Timetable

The “defence” is technically due 28 days after the particulars of claim are served.  However, the defendant usually applies to the court to extend this time limit and a 1-3 month extension is usually given.

After the defence has been filed, the court sends out a questionnaire to all parties; these are known as “directions questionnaires”.

Thereafter, there will be a court hearing (called a “costs case management conference”), when the court will set down a timetable of events to progress the case to trial and, in most cases, allocate both sides a “budget” for the costs that each side is allowed to incur going forwards.  Generally, the trial is scheduled to take place within 12-18 months of the claim form being issued.

The timetable generally includes:

  • production of various documents relating to the case (“disclosure”).
  • exchange of statements from you and all witnesses, including the health professionals responsible for your care (“exchange of factual witness evidence”).
  • exchange of expert reports (“mutual exchange of expert evidence”).
  • a meeting between medical experts on both sides to discuss the case and try to narrow the issues prior to trial (“experts’ meetings”).  This meeting usually takes place without the lawyers present.

The timetable then allows some time for negotiation between the parties, although this may happen at any point during proceedings. There is usually at least one further conference with your barrister and experts to review your case in detail and consider the best way to proceed.

Stage 5: Trial

Most cases don’t get to this stage because the vast majority of cases are settled without any court hearing. Once both parties have assessed the evidence in detail, it is often possible to negotiate a settlement.  Your case may be settled because the defendant no longer feels they are able to defend the case or proceed to trial.

If the case is brought by a child, or someone who lacks capacity to manage their own affairs, the court must approve any negotiated agreement.

Some cases do proceed to trial and it is always necessary to prepare for trial. At a trial, a judge will listen to the evidence, particularly the evidence of the independent experts, and decide whether or not your claim succeeds.  The length of the trial depends on the complexity of the case.

In some cases, the court will deal with just some of the issues in the first instance.  For example, the court often decides to have one hearing dealing with liability and, if this succeeds, another to deal with the amount of damages (this is known as a “split trial”).

Valuing your claim

As well as investigating whether you have a claim, we will also investigate the amount of compensation to which you would be entitled. The purpose of compensation is to return you, as far as possible, to the position that you would have been in if the medical negligence had not occurred.

In many cases, we will not fully investigate how much compensation you are likely to receive until the preliminary medical issues have been considered.  However, we will always be able to provide you with a broad outline at the beginning of the case.  It will be impossible for us to be more precise, because we will need to investigate how much you are entitled to and obtain evidence in support.  This can take time and involve additional experts.

The amount of compensation will depend on the severity of your injury and the financial consequences of your injury and will take account of:

  • your pain and suffering (“general damages”) and “loss of amenity” (which relates to your quality of life, if, for example, you’re now unable to carry out daily activities or hobbies).
  • any financial losses and expenses that you have incurred as a result of your accident (“past losses”). Evidence will be required to establish these losses.  It is therefore very important to keep an accurate record of these and evidence (pay slips, receipts etc) wherever possible.
  • any financial losses and expenses that you will incur as a result of your accident (“future losses”).

Pain and suffering

This is an amount of money to compensate you for the pain, suffering and loss of amenity attributable to your injury.  The court will consider guidelines and previous similar cases when attempting to value this part of the award.

Loss of earnings

Whether you were employed, self-employed, unemployed but looking for work; or a child at the time of your injury, you are entitled to claim for any loss of earnings you have suffered, or may in the future suffer, as a result of your injury.  Amongst other things, this could include:

  • loss of earnings
  • any amounts repayable to your employer under your contract for employment
  • any possible effect on promotion prospects
  • any loss of benefits of employment such as private medical insurance, car, fuel allowance, car servicing, insurance, free/reduced food at work, concessionary fares, free board and lodgings, cheap loans, staff discounts, SAYE or share option schemes, allowances including children’s education and housing, telephone allowance and mobile phone
  • any possible loss of pension
  • (where self-employed) any effect on the growth of the business.

In some circumstances, you may also be entitled to claim for your partner’s loss of earnings, if he or she has had to take unpaid time off on your behalf.

Assistance from others

Whether or not you have paid for it, you can often recover compensation for those who have provided and/or will help you in the future as a result of your injury.  Amongst other things, this could include:

  • nursing assistance
  • domestic assistance, e.g. shopping, cooking, cleaning, laundry, ironing
  • additional cost of maintaining accommodation, including DIY
  • gardening
  • car maintenance costs.

Medical treatment and prescriptions

You may be able to recover the cost of any private specialist treatment which has been required or may be required in the future because of your injury, for example, any medical treatment, physiotherapy, occupational therapy, speech and language therapy etc.

You are also entitled to claim the cost of individual prescription fees, pre-payment prescription certificates, painkillers, bandages etc in so far as they relate to your injury.

Accommodation

It may be that as a result of your injury, you have different accommodation needs.  Additional accommodation and adaptation costs, extra heating expenses, extra lighting expenses etc can all be included in your claim.

Specialist Equipment

A claim can also be made for any special equipment bought as a result of your injuries; eg wheelchairs, grabs, stair lifts etc.

Miscellaneous Costs

Other financial losses incurred as a result of your injury, can also be claimed, such as extra washing expenses, special diets, cancelled holidays, the additional costs of going on holiday, hairdressing, babysitters, telephone calls, travel expenses etc.

When is the compensation payment made?

During your case, it may be possible to obtain an interim payment of compensation from the defendant to help you purchase specific items such as a wheelchair, a car or a house.  This is usually only possible if the defendant has accepted liability for your claim.

At the end of the case, compensation may either be paid as a single lump sum or as ongoing annual payments (“periodical payments”) or a combination of the two.

You may be awarded provisional damages.  This is when there’s a possibility that your injury will get worse in the future, it’s possible for the court to assess the value of your injury as it stands at the time of the trial or settlement, but also make an order allowing you to come back to court if your injury gets worse. This must amount to a “serious deterioration”.

What about state benefits?

If the case is successful, certain state benefits might be deducted from your compensation and refunded to the government. In addition, if you receive compensation, your entitlement to benefits now or in the future may be affected.  In some cases, if may be possible to set up a Personal Injury Trust, which is a legal device, to prevent this happening.  At Tees our experts can advise you on this.

Investment Advice and Life Planning

At the end of the case, you may have a large sum of money.  Our expert Wealth Management Advisers are able to advise how best to invest this money to ensure that it meets your future needs and any other specific concerns that you may have.

Our specialist Private Client Team will be able to help you Make a Will and Lasting Powers of Attorney.

Court of protection and deputyship

If you have a serious mental disability and are not able to manage your affairs, an application will need to be made to the Court of Protection for a deputy to be appointed.  We can assist with the court application and provide advice to the deputy.  These costs will form part of the compensation sought in your claim.

Medical negligence: Quality of nursing care claims

If you are concerned about the standard of care a relative or loved one is receiving, there are steps you can take to help improve their situation. Our specialist Medical Negligence team offer valuable help and guidance. You can call our Medical Negligence experts on 080o 013 1165 for a free, confidential, no obligation chat.

What to do if a loved one isn’t getting the care they need

Recent reports in the press and by the BBC point to a ‘care crisis’ in the UK, and ongoing issues with the UK’s care system.  A recent report from the Care Quality Commission (CQC) has highlighted the sub-standard levels of care sometimes provided to patients across the UK. They report that many services are underfunded and overstretched, with staff shortages being a major area of concern.

If you have a loved one receiving care, or moving into a care home, they have the right to be treated properly. They might choose to receive domiciliary care at their own home, or through a residential or care home. Sadly, as documented by the press and the BBC, some carers and homes can sometimes fall short in the care they provide to patients.

There is no clear definition of poor care, and there can sometimes be a thin line between poor care, and abuse and neglect. The bottom line is this: is the person getting the support and help they need as identified in their care plan?

Common problems with care and care homes

When problems occur, it’s often due to a neglect of basic care needs, toileting, poor staff behaviour and the general happiness and well-being of the patient. Common issues include:

  • Injuries caused by falls, slips or poor handling by staff
  • Pressure sores
  • Errors in medication
  • Dehydration
  • Malnutrition
  • Late referrals for treatment

Seeing someone suffer because of poor care is emotionally very difficult. You might be worried for their safety, or unsure if you should speak up. However, there are steps you can take to help.

What to do if you have concerns about the quality of care

If you have concerns about the care a friend or relative is receiving, then there are several practical steps you should take. Don’t be afraid to raise a complaint. Although it can be a difficult task to discuss concerns relating to someone’s care, it’s important to remember that they have a right to be treated properly. Care homes and home-care agencies must be registered with the CQC and meet the minimum standards set. By law, all health and social care services must have a procedure in place for dealing with complaints.

As a first step, you should discuss your concerns with the patient. Make your own observations, or if you can’t be there, ask someone else to be present when the carer comes, or in the case of residential or nursing homes, visit the patient so that you can form a first-hand view of the level of care being provided.

Dealing with abuse by carers and care homes

If you suspect that your relative or loved one is receiving poor care or being abused in any way, ask them about it in private. Try to get as much detail as possible. Then, report the matter to the manager responsible for the patient’s care. Ask them for an explanation and an investigation. Follow up on your verbal complaint in writing.

If you witness abuse or have evidence that suggests basic standards aren’t being met, intervene as soon as you can to stop it. Write down what happened, and follow it up with the care manager. Keep copies of all documents relating to your complaint, recording important details like date, time, place and the names of staff involved.

You can also contact your local authority to report a problem – even if they don’t fund the patient’s care. All councils have procedures in place to deal with the care and protection of vulnerable adults. You should also inform the CQC, as they have legal powers to intervene and make care providers improve their service.

Brain injury at birth negligence claims

It is very rare for babies to suffer a serious brain injury at birth. However, the effects can be absolutely devastating and lifelong for babies and their families.

Some signs and symptoms of brain damage can be detected shortly after birth. However, this is not always so and some symptoms may not be apparent until several years later.

Medical negligence claims – baby brain injury due to midwife or doctor negligence

Sometimes, basic errors in care during an otherwise routine pregnancy and labour can, unfortunately, cause or contribute to a devastating birth injury.  If the way your baby’s birth was managed caused a brain injury, you may be able to make a claim on behalf of your child to secure financial compensation for their future needs. Research carried out by the Royal College of Obstetricians and Gynaecologists (RCOG) shows that 854 babies suffered a severe brain injury in 2015. Of these babies, 76% might have had a different outcome with better care.

The 2021/22 HSIB Maternity Investigation Report highlighted problems with the inconsistency in guidance across the NHS, and in some areas, a complete lack of any guidance at all. This has led to inconsistency in maternity care across England. Guidelines should protect the health of the mother and baby, and ensure that any problems are detected at an early stage.  They cover, for example:

  • what an initial assessment of the woman should include
  • the frequency of maternal observations (blood, temperature and pulse)
  • how the baby’s heart rate should be monitored and how to interpret the results
  • how frequently vaginal examinations should be performed
  • the use of pain relief
  • what should be done if things are not progressing as they might
  • interventions that may be taken to help deliver the baby.

Doctors and midwives are only human, but unfortunately, when they make mistakes there can be devastating consequences for babies and their families. Sometimes, medical professionals fail to follow the right procedures during labour. For example, any untoward changes in the baby’s heart rate, could suggest that the baby is in distress and, depending on the level of concern, may mandate an expedited delivery.  If a caregiver fails to correctly interpret the baby’s heart rate and delivery is delayed, this may mean that the baby has been starved of oxygen for longer than should have been the case and that this has caused brain damage.

Examples of mismanagement after birth may include:

  • poor management of resuscitation shortly after birth
  • a failure to treat jaundice
  • a failure to treat  low blood sugar levels promptly.

The most common mistakes tend to occur because of lack of experience, lack of training, poor communication between staff (for example, during a shift change), insufficient staffing levels and fatigue and stress (for example, if the delivery ward is particularly busy midwives might need to look after multiple labouring women at the same time).

If your baby has a brain injury and you are worried about the care you or your baby received, a birth injury claims solicitor can help you find a way forward. Brain-injured babies may have long-term and complex needs, and it is important that any solicitor has the necessary expertise in these cases to help you get the best for your child. Many children with brain injuries go on to lead full and independent lives, but some children may require lifelong care and specialist support (such as adapted housing, equipment and therapy) to help them live their lives to the fullest. At Tees we are committed to helping families get the support and security they need. Our birth injury claims specialists understand what you’re going through, and we can help you get answers about your care. We’ll listen to your experiences, and help you find out what happened. 

Caring for women in labour

There are protocols and guidelines that caregivers should follow when caring for women in labour. These are in place to protect the health of the mother and baby and ensure that any problems are detected at an early stage. They cover, for example:

  • what an initial assessment of the woman should include
  • the frequency maternal observations (blood, temperature and pulse)
  • how the baby’s heart rate should be monitored and how to interpret the results
  • how frequently vaginal examinations should be performed
  • the use of pain relief
  • what should be done if things are not progressing as they might
  • interventions that may be taken to help deliver the baby

Common causes of brain injury at birth

If the brain does not develop properly or if there is damage to the developing brain, this may cause a wide range of physical problems, in addition to behavioural and learning difficulties.

The most common brain injury related to birth trauma is Cerebral Palsy. Cerebral Palsy can occur before birth, during birth or soon after birth.

Problems before birth

Sometimes cerebral palsy can occur before labour and birth.  Some things increase the risk of a baby having a brain injury, for example:

  • problems with the mother’s blood pressure (‘pre-eclampsia’), thyroid, or maternal seizures
  • maternal infections during pregnancy
  • multiple births
  • premature births
Problems during labour

Sometimes cerebral palsy occurs because a baby is starved of oxygen during labour. This is called birth asphyxia. It means that the baby’s oxygen supply or blood flow to the brain was interrupted during birth. Serious complications (acute events) during the early stages of labour or during established labour can interrupt the baby’s oxygen supply.  For example:

  • the placenta separating too early from the uterus (‘placental abruption’)
  • problems with the umbilical cord
  • the baby getting stuck in the birth canal and shoulder dystocia  (where the baby’s head is born but the shoulder gets stuck).

Serious physical injuries can cause brain injury. If the baby suffers a skull, neck or spinal injury (such as a fracture) this can be very serious. Physical injuries can be caused by physical injury to the mother during pregnancy or by instrumental deliveries such as forceps deliveries.

Doctors might recommend an instrumental delivery if the baby needs help to be born. In very rare situations an instrumental delivery can cause brain injury if the instruments injure the baby’s skull (which is very soft), neck or spine. Such injuries are rare, and may be associated with improper or negligent use.

Problems after birth

Sometimes a baby is born in poor condition and it is important that they receive prompt and appropriate resuscitation.  If this does not happen, unfortunately, the baby may be starved of oxygen for too long and may have permanent brain damage.

Other complications after birth include jaundice and low blood sugar levels (‘hypoglycaemia’). Jaundice is relatively common in babies, especially premature babies. It is the yellow colour seen in the skin of many newborns. Jaundice happens when too much bilirubin (a chemical naturally produced by the body) builds up (‘hyperbilirubinemia’). If infant jaundice is treated immediately, there usually isn’t a reason for concern. However, if left untreated, high levels of bilirubin in a baby’s brain can cause a serious condition called acute bilirubin encephalopathy. A very low blood sugar level, if untreated, can also cause cerebral palsy.

For many parents, understanding what happened during their child’s birth – and why – can be extremely important. Whatever caused the baby to be born with a brain injury, it’s an incredibly difficult situation for any parent to go through.

Signs and symptoms of brain injury in babies

The signs and symptoms of brain injury vary and depend on the severity of the injury. Generally speaking, the more serious the injury, the more obvious the symptoms.

Doctors use a grading scale to classify the severity of brain injuries at birth. There are 3 grades: mild (Grade 1), moderate (Grade 2) and severe (Grade 3). More severe injury normally means the initial symptoms and long-term effects will be more serious.

A mild injury (Grade 1 hypoxic ischaemic encephalopathy (‘HIE’)) may not be obvious immediately after a baby’s birth. Parents of babies with mild brain injuries may notice their baby is irritable and has problems sleeping or feeding. Other signs include hyper-alertness or if the baby’s eyes are wide open. Normally, the symptoms of a Grade 1 injury last for the first 24 hours after baby’s birth. If your baby’s birth was particularly difficult, or you suffered complications during delivery, your caregivers may ask you to look out for these symptoms.

Severe brain injuries can cause serious symptoms immediately after birth. These may be immediately noticeable. For example, babies who are born very poorly may be pale and floppy when they’re born.

Symptoms of a moderate (Grade 2 HIE) injury include:

  • lethargy (low energy, lack of movement)
  • reduced muscle tone
  • decreased or absent reflexes (for example, the sucking or gag reflex)
  • clinical seizures
  • pale in colour

Babies who suffer a severe (Grade 3 HIE) injury may exhibit the following symptoms:

  • lack of response to stimulation
  • unable to breathe independently
  • low or no heartbeat
  • lack of muscle tone
  • pale in colour
  • clinical seizures.

In very sad cases, a hypoxic brain injury can even lead to a baby’s death.

Treatment for brain-injured babies at birth

When caregivers suspect a baby may be born in a poor condition, a paediatrician should be called. If an emergency situation arises, help should be summoned quickly. However, this often means that midwives, obstetric doctors and paediatric doctors rush to the mother’s bedside. It can be a very frightening experience for the mother, and those supporting her during labour. Ideally, mothers should be told about the potential for such a situation during their pregnancy (however unlikely it may be).

Resuscitation

A paediatrician will be present for the birth in order to resuscitate the baby (if necessary).

Depending on the seriousness of the baby’s condition, they will usually be admitted to a Special Care or a Neonatal Intensive Care Unit.  Although this can be frightening for parents, it means that poorly babies get the care and support that they need to help their recovery.

Neonatal Therapeutic Hypothermia (infant cooling)

Neonatal Therapeutic Hypothermia (infant cooling) is a relatively new way of treating brain-injured babies at birth. It involves lowering the baby’s body temperature. Research suggests that this can improve the chances of babies starved of oxygen at birth from developing serious brain injuries, such as cerebral palsy.

Oxygen deprivation to the brain can cause a ‘cascade’ of neurological injuries. It causes gradual death of brain cells which in turn can cause brain injury and, in very sad circumstances, it can cause the baby’s death. Cooling therapy works by slowing down your baby’s metabolism, which slows and prevents the death of brain cells following oxygen deprivation. Cooling cannot, however, reverse the brain injury that has already occurred.

If your baby suffered a serious case of oxygen deprivation, they may be ‘actively cooled’. Your baby may be placed on a special cooling mat, or have cooled packs placed around them, to reduce their body temperature. The baby will be looked after in the neonatal care unit and cooled to 33C for 3 days after birth. Alternatively, your baby may be ‘passively cooled’, a process which involves taking early steps not to warm the baby up. Doctors may recommend removing the baby’s bonnet or turning off the heater to keep her/him cooler.

Both treatments are time-sensitive, and guidelines recommend cooling to start within 6 hours of birth. Although infant cooling is relatively new, early research suggests it is effective in improving the chances of brain-injured babies.

Unfortunately, not all brain-injured babies are candidates for infant cooling. Doctors might not recommend it if the baby is premature, has a very low birth weight or has a serious problem with their heart or lungs.

Imaging

If your baby suffered a brain-injury at birth, your doctors should offer an MRI scan or CT scan of the head. These tests examine the baby’s brain and can show signs of injury to the brain. Scans provide doctors with a detailed image of your baby’s brain and skull, and can show if there is bleeding or swelling, ischaemic brain tissue or fractures to the skull.

Prognosis for babies with a brain injury

Every baby is different and their prognosis will depend on the extent of the damage, where the damage occurred and what treatment they received.

It is usually hard to say what the likely course of any future disability may be until the child is older and how, and to what extent they have responded to therapies and support. However, in many cases there are long-term physical, in addition to learning and/or behavioural difficulties.  In some cases, the child may also suffer epilepsy.

Children with cerebral palsy usually need life-long support from a multi-disciplinary team, which may include a Paediatrician, a Neurologist, a Neuropsychologist, an Orthopaedic Surgeon, Physiotherapists, Occupational Therapists, Speech and Language Therapists, social workers, educational psychologist, a mental health specialist.  It can be very difficult to access but such therapies and support are known to significantly improve outcomes.

Some children will grow up to be capable of independent living and meaningful employment. Others, sadly, will not.

Life expectancy also varies enormously. Many children with a mild brain injury will have a normal life expectancy. Those at the more severe end of the spectrum will, sadly, have a considerably shorter life expectancy. If you have any questions or concerns about your child’s prognosis you should talk with your caregiver.

If your child has a brain injury and you are concerned about the care you or your baby received talk to our birth injury claims specialists. We’ll listen to your experience and help you find out what happened. 

Brain injury at birth terminology

Below is a useful glossary of terms which you might hear in connection with brain injuries at birth.

Where appropriate, these terms are explained specifically in the context of brain injuries at birth.

  • Hyperbilirubinemia: a condition whereby there is too much bilirubin in the blood
  • Hypoglycaemia: low blood sugar levels
  • Hypoxia: where part of the body (in this case, the baby’s brain) does not receive enough oxygen
  • Hypoxic ischemic encephalopathy (HIE):  where the baby’s brain does not receive enough oxygen or blood and it causes a problem with the baby’s health
  • Hypothermia: a very low body temperature
  • Neonatal encephalopathy (NE): abnormal signs of brain injury shortly after the baby’s birth
  • Neurological: relating to the nervous system (the brain, spinal cord and nerves).

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