Failure to Treat

Advice and Assistance from Cohen Cramer

Claim for failure to treat: We acted on behalf of a Claimant in relation to an alleged breach of duty in treatment given to the Claimant which was alleged to have caused or materially contributed to the Claimant’s stillbirth of her foetus.

The breach of duty

The background to the claim was that when the Claimant first attended hospital, she was assessed as being suitable for midwifery-led care. A scan subsequently revealed that she had a low-lying placenta, however, the Claimant was told there was no cause for concern.

The Claimant subsequently self-referred to the Maternity Assessment Centre at the hospital after suffering generalised significant abdominal pain. The pain settled and she then had a large PV bleed. It was noted she had a low-lying placenta. She was admitted to monitor her PV loss.

No diagnosis of placenta praevia was made nor were investigations commenced to confirm that diagnosis. Care was not altered to consultant-led hospital care. She was told to re-attend if she had more bleeding but was not told it could be an emergency.

The injury sustained

The Claimant returned to the hospital when it was noted she had been complaining of abdominal tightening with discomfort. Since admission, she had continued to have blood loss.

The Claimant was told the pain she was experiencing was normal although she queried this as it was unlike her previous pregnancy. The Claimant returned the next day when brown PV loss was noted again. Still, her low-lying placenta was thought unlikely to be a concern.

Days later, she attended hospital again with a history of significant further fresh PB bleeding, including the passing of clots. She was admitted again. No diagnosis of placenta praevia was made or attempted. No ultrasound was taken. She was internally examined and reassured that she was not losing bits of placenta.

On-going breach of duty

The Claimant saw her midwife again. The pregnancy was noted to be large for the gestation age. No plan was formulated to deal with the size and no explanation was provided to the Claimant about the potential complications that resulted therefrom. The Claimant was re-admitted to hospital a few days later with a history of fresh PV bleeding that morning which included clotting.

A couple of weeks later, the Claimant was again admitted to hospital. She had suffered a substantial PV bleed at home and had large clots again. It was decided to put her on steroids, indicating a serious risk of the need for premature delivery. The Claimant was simply told that the baby might come early or they might book her in for a caesarean section. She was not told there was any danger or that she might require an emergency caesarean section. The Claimant had further bleeds and clotting. She was kept in overnight and was sent to the scan department for a scan.

A week later, it was noted the baby was in an oblique breech position. She was discharged home. Despite being managed at home, the Claimant was not encouraged to have safety precautions in place, including having ready access to the hospital. The Claimant was not told to re-attend immediately if she experienced any bleeding, contractions or pain or supra-pubic period-like aches, no ultrasound imaging was taken and no diagnosis of placenta praevia was made or attempted.

The Claimant attended hospital again for a scan but was told by the hospital that this was not going ahead. Her bleeding had continued. The Claimant asked the consultant whether she would need a caesarean section, either booked or an emergency. She was told that she would not need one and was reassured that everything was fine and the chances of her going full term were fine. Her concerns about placental abruption were also dismissed and she was told the bleeding was probably caused by placenta slightly tearing. Another appointment at 36 weeks was planned with no monitoring until then.

The Claimant was not told she was at elevated risk of pre-term delivery and severe morbidity. The Claimant was not warned of the risks associated with placenta praevia or placenta accrete. Furthermore, the Claimant was not told that if she had any further bleeding, contractions or pain (including vague supra-pubic period like aches) or problems that she must immediately re-attend the hospital. Nor told that her baby might need to be delivered as an emergency caesarean section. This meant that when the Claimant continued to suffer further bleeds, given the history of her pregnancy so far, she was not overly concerned.

A week later, Claimant experienced the onset of abdominal pains in the afternoon, having experienced foetal movement during the day. Around tea time, the Claimant experienced a large bleed when she went to the toilet. An ambulance was called.

Hospital admission

The Claimant was admitted to hospital and a CTG was commenced and the foetal heart rate was monitored. An ultrasound scan revealed the baby was still breech. An artificial rupture of the Claimant membranes was performed and clear liquor noted, despite the placenta praevia and the unstable breech position of her baby.

The Claimant was not transferred to theatre until hours later with the initial intention of performing an emergency caesarean section.  A decision was then made to try a vaginal delivery. Parts of the placenta were delivered first. It disintegrated during delivery. The Claimant’s baby was delivered breech, floppy and pale with no signs of life and no steps were made to try and resuscitate the baby. It is notable that Claimant was later wrongly told that her baby had likely died before she got to the hospital. On account of the Defendant’s breach of duty and clinical negligence personal injury and loss was caused to the Claimant.

Pursuing the claim

Expert evidence from a Consultant Obstetrician and Gynaecologist confirmed that the Defendant did not follow the appropriate guidance for antenatal and obstetric care in the presence of suspected placenta previa and that there was a failure to make the diagnosis of placenta previa. Furthermore, the expert confirmed that there was a failure of plans to discuss the management of any further bleeds in the latest stage of pregnancy and the need for delivery by Caesarean section and no explanation for the decision not to attempt to resuscitate the baby.

A Letter of Claim was sent to the Defendant, with the Defendant providing a Letter of Response which confirmed that both breach of duty and causation were denied.

Investigations continued and court proceedings were issued. Further expert evidence was obtained from a Consultant Psychiatrist.

Settlement of the claim

The claim subsequently settled with the Claimant making an offer in the sum of £27,500.00, which was accepted by the Defendant.

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