Category: Medical Negligence

Premature babies are at risk of an eye disease called Retinopathy of Prematurity (ROP), which may, in serious cases lead to blindness.  This is why premature babies should be regularly screened in line with the 2008 National Guidelines.

In most cases, even if a baby does develop ROP, it will resolve spontaneously and treatment will not be needed.  For a small number of babies, ROP worsens, often very rapidly, but with timely treatment the prognosis is good.

What is retinopathy of prematurity?

Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry syndrome is where the blood supply to the retina does not develop normally as a consequence of being born prematurely. The retina is the layer of tissue that lines the back of the eye and makes it possible to see.

Your baby’s eyes begin to develop around the 16th week of pregnancy.  If he or she is born very early, this process is cut short.  The blood vessels in the inner retina do not develop a blood supply until much later in the pregnancy and this process does not complete until the end of the pregnancy.  Therefore, if your baby is born prematurely, the inner retina has an incomplete blood supply. The more premature the birth, the less complete the blood supply present.

In most cases, the premature baby’s eyes will develop normally. However, in some cases, the blood vessels in the inner retina do not grow normally.  They may grow into other parts of the eye such as the clear gel that fills the space between the lens and the retina of the eyeball and cause bleeding/leaking.   The vessels may also change physically, to pull the retina, and, if extensive enough, cause the whole retina to detach from the eye.

Over time, these blood vessels and the associated scar tissue can cause other serious vision problems, such as:

• Crossed eyes (strabismus)
• Increased eye pressure (glaucoma)
• “Lazy eye” (amblyopia)
• Near-sightedness (myopia)

The good news is that with early diagnosis and treatment, most babies will retain a normal structural eye, with good vision.

Retinopathy of prematurity medical negligence claims

Sadly, ROP occasionally gets missed and by the time it is detected, the baby has suffered permanent visual loss.  Janine Collier, Head of the Medical Negligence team at Tees, has specific expertise in helping families whose child has suffered permanent visual impairment because of a failure to detect and treat ROP. If your baby has suffered visual loss as a result of late diagnosis you may be eligible for compensation. Read on to find out more about this condition or click below to speak to a specialist solicitor.

What are the risk factors for ROP?

The risks increase with increased prematurity and the smaller your baby is at birth, the greater the chance of her or him having ROP.  There are other factors which contribute to the risk including:

• Ventilation
• Bronchopulmonary dysplasia
• Chronic lung disease
• Other inter-current illnesses such as infections, cardiovascular instability
• Poor post-natal weight gain

How do I know if my baby has ROP?

All infants who are at risk for it should be screened in line with the 2008 National Guidelines. The timing of the first screening examination will depend on your baby’s gestational age at birth.

The baby is given eye drops to make her or his pupils larger ahead of the examination.  This helps the doctor see all the parts of the eye better. It doesn’t hurt.

As the screening is not an especially comfortable examination, local anaesthetic eye drops are usually used alongside comfort care techniques, such as swaddling, oral sucrose or expressed milk, a dummy / pacifier.  Experienced ophthalmologists can usually undertake the examination in 2-3 minutes.  Each eye is fully examined to check for ROP.

Screening is usually carried out two-weekly, and, if no cause for concern, stops at around 36 weeks gestational age.

If the ophthalmologist identifies early signs of ROP, the interval may be shorter as the doctor will watch to see if the condition requires treatment, or if it resolves spontaneously.  Most babies with ROP will resolve spontaneously.

If my baby has ROP, what treatment will he or she need?

In the UK, approximately 4% of cases require treatment.  The purpose of treatment is to preserve the anatomy of the retina, by preventing retinal detachment.

If the doctor recommends treatment, this is usually given within 48-72 hours and most commonly, it is treated with laser to the affected part of the retina.

Your baby may suffer some side effects, including inflammation (typically treated with a short course of steroid eye drops and pupil dilating eye drops for 1 to 2 weeks).  Rarely, other side effects may occur. Your baby’s doctor should explain these to and discuss these with you prior to treatment.

I am worried about the care my baby is receiving – what should I do?

You might already have tried to talk to doctors about your baby’s condition but sometimes it can feel like you’re on your own. With Tees by your side, you are not.  We understand what you’re going through, and we’re here to give you a voice.

We’ve handled many medical claims and have a particular expertise in supporting families with babies and young children, so our team of lawyers really do have the practical experience to support you. We’re persistent, and we’ll fight to get answers for you and you may be eligible for compensation.

Retinopathy of prematurity: Case studies

Baby A: Rentinopathy of prematurity due to inadequate care

Baby A was born prematurely at 25 weeks and 4 days gestation by caesarean section. He suffered respiratory distress, was intubated and transferred to the NICU for a period of intensive care and specialist support.  He remained ventilated for 9 days, spent 22 days in Intensive Care and 7 days in the high dependency unit.  During his admission, he received antibiotic treatment for sepsis, insulin for hyperglycaemia and two blood transfusions.

Baby A’s parents understood that he was at risk of ROP.  However, his parents also understood that their baby would be regularly screened, so that if there were signs of ROP, he could receive treatment, significantly reducing the risk of loss of vision.

Five weeks after birth, Baby A had his first screening for ROP. At the time of the exam, Baby A was still small and in an incubator. When screened, each eye examination took around 10 minutes. Parents were advised that he would be screened every two weeks.

Baby A was transferred to a Special Care Baby Unit at a local hospital.  Parents felt that the care at the local hospital was very different to what they had experienced at the previous hospital. They felt the staff treated them as over anxious young parents and did not encourage them to be a part of their baby’s care, which was unlike their experience at the previous hospital.

Whilst at the local hospital, Baby A was screened twice for ROP over a six-week period. Prior to being discharged, the Ophthalmologist spent an extended period of time examining Baby A’s eyes. During the exam the Ophthalmologist cut the white part of Baby A’s eye.  After a time the despite the Ophthalmologist being unable to get a clear view, Baby A was discharged from hospital.

At a paediatric follow up the following month, Baby A’s parents told the Paediatrician that they were worried about his eyes as he would not look, follow or track.  The Paediatrician said that it was just because he was a young premature baby and that they should not worry.

One month later, Baby A was referred to Great Ormond Street (GOSH) for assessment. Baby A’s parents were told that he had suffered significant and severe visual loss, equivalent of Stage 5 ROP / retinal detachment in the left eye and Stage 4a ROP in the right eye.

Baby A had surgery on the right eye at GOSH.  The estimate is that post-operation he may have 2% vision in his good right eye since having the operation.  It was not possible to offer Baby A any treatment for his left eye.

The outcome

The hospital that treated Baby A has admitted that the diagnosis of ROP should have been made several weeks earlier and that laser treatment should have been offered within 48-72 hours of diagnosis.  Now that liability has been admitted, we are seeking an interim payment to put in place some immediate support for Baby A and his family (aids, appliances, accommodation, educational support).

As a result of a review, the hospital has changed their process and procedure for ROP screening. The Ophthalmologist no longer undertakes ROP screening and the Paediatrician no longer reviews premature babies.

Baby C: Late diagnosis of retinopathy of prematurity

Baby C was born at 24 week’s gestation, weighing c. 600 grams.  She suffered several complications because of her extreme prematurity including Respiratory Distress Syndrome, Chronic lung disease, Hypertension, a patent ductus arteriosus, sepsis, hyperglycaemia and necrotizing enterocolitis.

Due to her prematurity and low birth weight, C was at high risk of suffering from ROP.

Baby C was examined by an ophthalmologist at, 7 weeks old, 8 weeks old, 9 ½ weeks old

On all occasions, it was noted that there was no ROP.

At ten and a half weeks of age, Baby C was again examined. The ophthalmologist found and recorded a “definite progression of ROP stage 3 zone 2 in both eyes, + disease”.

Treatment by both laser and cryotherapy was undertaken, but, the disease being so extensive now, was unsuccessful.

ROP behaves in a highly predictable manner and, we were, therefore, able to infer that at the time of the examination when C was 9 ½ weeks of age, it is implausible that there was no ROP present.  The examination must, therefore, have been substandard.  With a competent examination, C would have been referred for urgent laser treatment and, on the balance of probabilities, she would have retained good functional vision in both eyes.

Baby C lost all vision in her left eye, and has a shrunken eye.  She has lost most useful vision in her right eye.  She is at risk of retinal detachment, retinal degeneration, the need for surgical treatment of the band keratopathy, glaucoma and shrinkage of the right eye.

C also suffers from learning, behavioural and social difficulties because of her extreme prematurity.  Her visual impairment has compounded her other developmental problems.

This case has now settled for a six figure sum.

Radiology, including X-rays, CT scans and MRI scans, is a routine part of healthcare used to identify problems, guide treatment and exclude potential diagnoses. Failures in radiology services can unfortunately lead to failures in identifying potential abnormalities and delayed or misdiagnosis.

Our medical negligence solicitors are experts at dealing with claims resulting from delayed diagnosis, failure to diagnose and misdiagnosis. The team also handles cases involving failures to identify or report on suspicious or abnormal features following an X-ray, CT scan or MRI scan, and failure to make appropriate recommendations for referral.

Sadly, we are seeing a rise in delayed radiology cases as a direct result of the ongoing pressure on the NHS and some underlying factors impacting the delivery of imaging services, resulting in life-changing consequences for patients and their families.

How do delays to scans occur?

When a patient is referred for an x-ray, MRI or CT scan there should be a set time frame within which this is carried out, depending on the reason for the referral. Unfortunately delays in referrals and failings in communication between different departments and health providers can mean that these targets are not met, leaving the patient with a potentially delayed diagnosis.

Once the imaging is undertaken it is then reviewed by the relevant clinician, and a report is prepared. Where possible, images should be compared to any previous order to highlight developments and changes over time, although a clinician’s ability to do this is reliant upon previous imaging being available to them at the right time.

Claims resulting from the failure to identify suspicious features leading to delays in diagnosis of health issues such as cancer have devastating consequences and in some cases have led to the avoidable death of a patient.

Once the scans have been reviewed, any abnormal findings should then lead to referral to further investigation or treatment. Again, delay at this point is a frequent and potentially significant problem, as miscommunications between departments and systems or flagging errors occur due to many different factors.

What is the impact of delayed diagnosis following a scan?

Delays in diagnosis as a result of poor radiology practices can be devastating particularly in cases where patients are suffering from conditions or diseases where timely diagnosis and treatment is of paramount importance, such as cancers or acute respiratory events.

It is not unusual for there to be a number of errors throughout the process, each representing a missed opportunity for earlier diagnosis and treatment, which can ultimately lead to lengthy delays in diagnosis and treatment.

Our medical negligence team has recently dealt with cases involving:

• A 7 – 22 month delayed diagnosis of lung cancer following a failure to arrange correct imaging in November 2018 and to follow up abnormalities identified on imaging in March 2019 and February 2020. Diagnosis was not made until September 2020.
• Incorrectly reported ultrasound undertaken by an outsourced radiology provider in November 2018, as a result of which the patient suffered a delay in diagnosis of colorectal cancer between approximately November 2018- May 2019 which impacted upon her treatment options and life expectancy.
• Failure to identify a lung lesion as suspicious for malignancy on a CT scan and negligently reporting the lesion as a benign pleural cyst. The scan was undertaken at an NHS hospital but the reporting was outsourced to an outside company. As a result, the patient suffered a delay in diagnosis of around 11 months leading to the progression of his disease and denying him the opportunity for curative treatment- ultimately his death could have been avoided.
• Failure to identify an abnormality on a chest X-ray and to refer for further investigation. As a result the patient suffered a delay in diagnosis of lung cancer of around 8 months, leading to a loss of life expectancy of around 10 years.
• Failure to report a hepatic flexure tumour on CT scans in both June and November 2018. Potentially a further failure to miss an abnormality in November 2017. As a result, our client had a delay in diagnosis of colorectal cancer for 16 months, potentially 24 months.
• Failure to refer for appropriate follow up after identifying a vestibular schwannoma (auditory benign tumour) leading to a delay in informing our client of this finding and putting a treatment plan in place of 21 months. As a result of this delay, the tumour grew and our client developed hydrocephalus with associated balance, continence and cognitive symptoms, required admission to hospital for around a month, developed permanent facial palsy with associated visual, cosmetic and speech issues, required shunt insertion surgery and was unable to undergo standard radiotherapy treatment.

What are the factors leading to medical negligence claims relating to radiology?

• a concerning shortage of radiologists in the United Kingdom. With radiology services often stretched and under pressure to achieve quotas and targets, the risk of human error increases
• systems errors and poor referral methods. Different hospitals, health centres and departments frequently use different systems and referral pathways, making delays and missed requests more likely
• outsourcing of radiology. Due to the lack of radiologists a number of NHS Trusts have begun to send imaging to external companies for review, some of which are outside of the UK. Issues in reporting standards in outsourced reports seem to be increasing, and there are additional problems in ensuring the external radiologist is provided with the correct supporting medical records and previous imaging
• lack of correct equipment, equipment errors or cost constraints on how many patients may be referred for imaging

A recent report by the Parliamentary and Health Service Ombudsman (PHSO) has shown recurrent failings in the way radiology is reported on and followed up across NHS services, and the PHSO has written to the Government recommending urgent improvement to NHS imaging services be implemented as a priority.

Some important things to consider if you require radiology services

It can be difficult for patients to avoid errors as predominantly it is the reporting of the radiology which is the issue, however there are some practical tips to consider if you find you require radiology:

• If referred for radiology ask what the timeframe for this should be and which hospital and department the referral will be made to
• Re-iterate your symptoms to the clinician carrying out the imaging, and let them know if anything has changed since your referral
• When discussing the results with your clinician, ask whether there were comparisons to any previous imaging or any ambiguous findings
• If you are concerned that there has been an error in the reporting of your imaging flag this to the clinician and ask for an immediate review
• If you are referred for further investigation or treatment following radiology check what the timeframe for this should be, when you should hear further, whether you need to make an appointment yourself, and who the referral will be made to

Here at Tees we are experienced in dealing with a range of claims relating to issues in radiology, and work with a number of eminent independent experts to ensure that no stone is left unturned in investigating the standard of care provided.

If you are concerned that there were failings in your care or potential delays to your treatment as a result of issues or errors in radiology we work on a no-win, no-fee basis, and would be happy to discuss your experience. We’re here to help.