Hospital negligence news

 

Brain injury acquired in childhood: when the signs of damage emerge years later

Nicola Anderson, associate - solicitor with Boyes Turner's specialist medical negligence team discusses what happens when the signs of a childhood brain injury effect adulthood.

What is acquired brain injury or ABI?

Brain injury occurring in childhood can be the result of a trauma, such as a fall or a blow to the head (a traumatic brain injury). Brain injury may also develop following an illness. Regardless of the cause, if there was a period of normal development before the brain was injured, this type of injury is called an acquired brain injury or ABI. 

Which illnesses can cause brain injury?

There are several types of illness which have the potential to cause damage to the brain. For example:

  • Meningitis (a swelling to the lining of the brain, caused by either a viral or bacterial infection);
  • A stroke (interruption to the blood supply to the brain);
  • A brain tumour;
  • Epilepsy;
  • Hypoglycaemia ( very low blood sugar levels).

Is a brain injury always obvious?

The answer is no, not always. On discharge from hospital, children may seem well in themselves and parents will be reassured that a good recovery has been made. If there are any immediate difficulties (for example fatigue, or problems with mobility), the symptoms may be subtle, or they may come and go. Alternatively, there may be no signs at all that the child has suffered a brain injury, with symptoms only becoming apparent years later as their brain develops, and the mental load placed upon them increases.

What are the symptoms of acquired brain injury?

There is no typical case. Every child, and every injury, is different. However, issues arising in childhood may include:

  • Physical problems such as reduced mobility, or difficulty with balance or coordination (for example, the child may appear clumsy);
  • Onset of epilepsy;
  • Impaired speech;
  • Hearing loss;
  • Visual disturbance;
  • Behavioural difficulties, such as defiance, or being impulsive;
  • Mental health problems, including depression and other emotional difficulties, for instance being quick to anger, or prone to anxiety;
  • Fatigue;
  • Difficulty concentrating, recalling information, planning, and learning in general;
  • Finding it difficult to make and maintain friendships.

Whilst this is only a summary of the difficulties children with acquired brain injury may experience, it highlights how diverse the symptoms can be, and how one symptom may feed in to another. For example, a child who is tired will struggle to learn. They may become frustrated by their slow progress and have frequent emotional outbursts, which may worsen during the teenage years. These outbursts will make it difficult for them to maintain relationships with others, both at home and at school, and their mental health may suffer. It is not surprising then that a child’s brain injury, caused years earlier during an acute illness, may be mistaken for other conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), dyspraxia, or autism. The link with the long forgotten childhood illness may not be immediately apparent.

What should I do if I suspect my child has an acquired brain injury?

It is important to seek support early and to make others aware that your child may have an acquired brain injury. All mainstream schools will have a Special Educational Needs Coordinator (SENCO) responsible for identifying children with additional needs and they are likely to be a good first port of call, as are support organisations such as The Child Brain Injury Trust and Meningitis Now.

How can Boyes Turner help me secure support for my child within school?

The education team at Boyes Turner are experts in the law relating to Special Educational Needs (SEN). We can assist parents with matters relating to Education, Health and Care Plans (EHCP’s) and securing support within schools.

Can my child claim financial compensation for their acquired brain injury?

It may be possible to bring a claim for financial compensation if it can be established that the child’s brain injury was caused, or contributed to, by the negligence of another, such as:

  • a doctor or hospital trust failing to correctly diagnose and/or correctly treat the initial illness, therefore causing, or increasing the risk of a brain injury (a medical negligence claim);
  • the driver of a vehicle causing a road traffic accident (a claim for personal injury);
  • a local authority, individual or company failing to safely maintain an environment, for example, a playground, or public park (again, a claim for personal injury).

Please do get in touch if you think your child may have a case and our specialist claims team can advise you further.

Are there time limits for bringing a claim?

There are time limits for bringing a claim.  

A child generally has until their 21st birthday to pursue a claim (three years after turning 18),  however, in some circumstances, it may be possible to bring a claim after this. To protect your child’s right to make a claim, advice should always be sought from a brain injury specialist solicitor as soon as possible.

If you are caring for a child who has suffered an acquired brain injury and you would like to find out more about making a claim, contact us by email at claimsadvice@boyesturner.com.

Delayed diagnosis of cancer - Can I make a claim?

According to cancer charity, Cancer Research, every two minutes someone in the UK is diagnosed with cancer. The NHS deals with over 350,000 new cases of cancer each year. Around a third of those are diagnosed via the ‘two-week-wait’ referral rule, a quarter following a routine or urgent GP referral, and a fifth are diagnosed (often at an advanced stage) after presenting as an emergency.

Cancer survival has doubled in the UK over the last 40 years, with significant variation in survival between cancer types. 89% of cancer patients in England rate their care as very good or excellent. There are National Institute for Clinical Excellence (NICE) guidelines in place, designed to help doctors refer patients with suspected cancer earlier and more directly to the resources that can help them, with the aim of reducing delay between onset of symptoms, referral, diagnosis and treatment, but despite these measures, sadly, for a small minority of patients, unacceptable delays still occur with devastating consequences.

What type of cancer delays lead to compensation claims?

Some types of cancer (breast, cervical and bowel) are subject to national screening programmes which should identify abnormalities at an early stage.

Women aged 25 to 64 are invited to undergo cervical screening every three years. This is extremely valuable as abnormal cells can be detected early and then monitored or treated before these become cancerous. Early detection of potential cancers through screening saves lives. Where claims occur in these circumstances, they tend to arise when smear tests are misreported as being normal when in fact there are abnormalities, or when patients who need follow up or treatment are not notified or recalled.

All women aged 50 to 71 are also invited to undergo breast cancer screening every three years. If a woman has an increased risk of developing breast cancer, for example, due to her family history of the disease, she may be eligible for screening below the age of 50. Screening consists of an X-ray (mammogram). Mammograms can detect breast cancer early, possibly before there is a noticeable lump. Unfortunately, there have been instances of women not being invited to attend breast cancer screening, misreading of mammograms and failure to call patients who are identified as having abnormalities for treatment.

If a person starts experiencing symptoms that could be suggestive of cancer it is important that their GP recognises their potential cancer symptoms and makes the appropriate referral for investigation or treatment. The National Institute for Clinical Excellence (NICE) has produced guidelines for GPs to follow that clarify when a person should be referred to a specialist for further investigations. These are very effective, but we continue to see clients who have attended their GP on a number of occasions, sometimes over a considerable period of time, complaining of potential cancer symptoms before their concerns are acknowledged and they are finally referred, leading to delayed diagnosis and treatment of their cancer.

How is claim arising from a delay in diagnosis and treatment of cancer valued?

There is no set compensation award for a claim of this type, so each case is valued according to our client’s own circumstances. It is important to understand that any injury arising from the disease itself, which the patient would still have suffered even if she had been promptly diagnosed and properly treated, will not be compensated. A successful claim will provide compensation for the additional physical and often psychological injury and financial loss that the patient suffered as a result of the negligent delay in diagnosis, the failure to treat promptly or the pain and side effects of the more radical treatment that was only required owing to the progression of the disease during the negligent delay.

How is pain and suffering compensated?

The claim includes a payment for ‘general damages’ which reflects the pain, suffering and loss of amenity caused by the GP or hospital’s negligence. This aspect of the damages award generally follows guidelines which are based on what the court has previously ruled as an appropriate level of compensation for that type and severity of injury.

Are my financial losses also compensated?

‘Special damages’ is the name given to the aspect of the award which compensates for ‘out of pocket’ expenses that the patient has actually paid or financial losses that they have suffered as a result of the delay in diagnosis.

What other types of injury or loss are commonly claimed in a delayed diagnosis or treatment of cancer case?

Discussed below are some common losses arising from delays in the diagnosis or treatment of cancer. This is not an exhaustive list and depends on the individual client’s own experience, the nature and severity of their additional injury and their financial circumstances. We work with each client to understand how the negligent delay has affected them. We may also instruct experts to comment on specific items listed below, for example which aids and equipment would be of benefit or which adaptations to property are required.

  • Additional Treatment
    The pain, injury or disability caused by additional or more radical treatment and the costs associated with it are considered when assessing this aspect of the claim.

    If there is a delay in diagnosing cancer the affected person may have experienced treatment that would not have been required if the cancer had been picked up at an earlier stage. Delays in diagnosis of cancer can lead to more intrusive and significant surgical procedures than would have been the case had it been recognised earlier.

    Early treatment for cervical cancer may consist of a cone biopsy (where tissue is removed from the cervix) and/or trachelectomy (removal of the cervix) but progression of the disease during a delay in diagnosis might mean that the patient needs a radical hysterectomy, which would otherwise not have been necessary. Not only is this a more significant procedure with more risks of complications and longer recovery time, but it results in the woman becoming infertile. In these circumstances we would consider not only the impact of more intrusive surgery, but the emotional/psychological impact and costs arising from infertility.

    Delays in diagnosis of cervical cancer can lead to a person undergoing chemoradiotherapy and brachytherapy which, again, could have been avoided if signs of the condition had been picked up at an earlier stage.

    If breast cancer is diagnosed at an early stage, treatment may consist of a lumpectomy, a breast-conserving surgical treatment in which the tumour (but not the breast) is removed. In more advanced stages, treatment may be mastectomy, which is removal of the whole breast as well as reconstruction. If delay in diagnosis has led to a mastectomy where, but for the negligence, a lumpectomy would have been offered, the impact of the more intrusive surgery will be reflected in the value of the claim.  Delays in diagnosis of breast cancer can also lead to the woman requiring chemotherapy which would not have been required if the cancer had been identified at an earlier stage.

    Not only do these more intrusive treatments have a significant impact on the person at the time, but the long-term consequences can be devastating. The claim takes into account past, ongoing, and future costs and consequences arising from additional treatment.
     
  • Loss of Earnings and Pension

    If a person has had to take time off unpaid, take a pay cut to change jobs, or cut down on hours as a result of treatment undergone as a result of the delay in diagnosis there will be a claim for net loss of earnings and pension.
     
  • Care and Assistance

    A loved one may have had to take time off work to care for someone during and/or after treatment that could have been avoided if cancer had been identified sooner. In this case there will be a claim for their time. Professional carers may also need to be employed either in the short or longer term to assist a person with care needs arising from additional injury caused by their delayed cancer diagnosis.
     
  • Medical Expenses

    These include the cost of prescriptions and also the cost of any therapies that may be of benefit, possibly including physiotherapy and/or occupational therapy.
     
  • Travel Expenses

    The costs of travel to and from medical appointments which are required as a result of the delay in diagnosis, for example, can be claimed.
     
  • Aids and Equipment

    An expert may be appointed to comment on any aids and equipment which might be of benefit.
     
  • Adaptations to Property

    The consequences of delayed diagnosis and treatment of cancer can lead to long term disability. Where our experts believe that our client’s home needs adaptation to suit our client’s disability, [for example to provide a more accessible bathroom if bowel and/or bladder function are impaired] the reasonable costs of these adaptations can be claimed. 
     
  • Psychological counselling

    Severe, life-threatening injury, fear of recurrence of the cancer and the intensely personal nature of the disability caused by delayed cancer diagnosis and treatment can be very difficult to come to terms with. In these circumstances some people need psychological help to overcome anxiety or adjustment disorders, depression and PTSD. Where our experts believe that our client would benefit from counselling we are often able to recover the costs of such treatment as part of the claim.
     
  • Loss of dependency and bereavement

    Where negligent delay has caused someone’s death, we can help the bereaved and dependent spouse and children obtain compensation for their loss of dependency and other claimable losses.

If you have suffered severe injury or have been bereaved as a result of delays in  cancer diagnosis or treatment and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com.

Can I claim surrogacy costs after negligent cervical cancer?

Delays in diagnosis and treatment of cervical cancer can be fatal or can result in the need for radical treatment with ongoing side-effects such as pain, premature menopause, impaired bowel and urinary function, painful sexual intercourse, fear of recurrence and psychological damage.

What side-effects from late-treated cervical cancer can be compensated?

We can usually help clients recover compensation for these aspects of their injury but we know from our clients that one of the consequences of late-treated cervical cancer that they find most difficult to come to terms with is loss of their fertility, particularly in younger women who were hoping to have their first or further children in the future. Whilst fertility treatment options are available, such as IVF treatment, some women are not suitable for such treatment and, if they are to have a child of their own, need to have a surrogate.

Until recently, whilst it was possible to recover compensation for many aspects of a late-treated cervical cancer injury, it was not possible under English law to claim for the costs of surrogacy which was needed owing to infertility caused by the delay in treatment for cervical cancer. This left many seriously injured women without an effective remedy for one of the  most distressing consequences of their injury.

How has the law changed to compensate for surrogacy costs?

In 2018 there was a development in the law which opened the way for surrogacy costs to be successfully claimed where a woman has been left infertile as a result of a delay in diagnosing cervical cancer.

The medical negligence case of XX v Whittington Hospital NHS Trust concerned a young woman of 29 whose diagnosis of cervical cancer was negligently delayed by four years. As a result of the delay, she needed more radical treatment than she would have had if her condition had been properly managed. She underwent chemo-radiotherapy which caused irreparable damage to her uterus and ovaries. The woman and her partner wished to have their own biological children using a surrogate. To do this they wanted to go to the USA for surrogacy treatment and, therefore, wished to claim the costs of this.

When the case first came to court, the injured woman was awarded the costs of UK-based surrogacy for two pregnancies but was refused the additional costs associated with surrogacy in the USA. She successfully appealed the court’s decision and was awarded the costs of undergoing surrogacy in the USA.

Boyes Turner’s medical negligence specialists have helped many severely injured women and bereaved families recover compensation following misdiagnosed, delayed or incorrectly treated cervical cancer. We understand the emotional, psychological and physical damage that these injuries cause to the women and their families and welcome this recent development in the law which we hope will open the way for more women in this situation to begin to rebuild their lives by being able to have a child.

If you have suffered serious injury or family bereavement as a result of negligent diagnosis or treatment of cervical cancer and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com.

Awareness of the signs and symptoms of sepsis

According to The UK Sepsis Trust, every year 52,000 people in the UK die from Sepsis. Those that survive this aggressive infection/illness, can be left with very severe injuries and complications.

Boyes Turner solicitors are medical negligence specialists with experience dealing with cases relating to the diagnosis and treatment of sepsis. We have helped many clients and bereaved families who have been affected by life-changing or fatal sepsis obtain compensation for their injuries, including amputations.

Sepsis in the news

The signs and symptoms of sepsis have been regularly highlighted in the news and in social media in recent months and years.

A few years ago, the film Starfish (2016) brought the story of Tom Ray to the screen. Tom rapidly developed the infection and deteriorated over a day. The illness caused him to go into a coma. Although Tom recovered from the potentially life-threatening illness, as a result of it, he required quadruple amputations and facial amputations. Tom’s story highlighted the signs and symptoms of sepsis and the importance of acting quickly to treat it.

Earlier this year, Coronation Street’s Jack Webster developed sepsis after cutting his knee playing football. The storyline raised further awareness of the signs of sepsis in children.

Melissa Mead has campaigned to raise awareness of sepsis following the devastating loss of her 12 month old son, William, in December 2014. William developed sepsis following a chest infection. Melissa is an ambassador for The UK Sepsis Trust and was recently awarded an MBE for her campaign work.

The UK Sepsis Trust have recently announced their partnership with Iceland Foods Charitable Foundation. As part of this, in the future we will be seeing information about sepsis, and how to spot it, on the side of milk cartons sold in Iceland stores. Founder and CEO of The UK Sepsis Trust, Dr Ron Daniels BEM regularly highlights the signs and symptoms of sepsis in both adults and children on social media.

As sepsis claims specialists, the Boyes Turner team see first-hand the life-altering effects sepsis can have and what happens when there is a delay in treatment and we support the efforts of all who are raising awareness of the importance of recognising the signs early so that appropriate treatment can be given.

What are the signs and symptoms of sepsis in children?

Identifying the signs and symptoms in children can be difficult, particularly in young children who may not be able to talk and explain how they are feeling. It is important to be aware of the following signs:

  • fast breathing;
  • fitting or convulsions;
  • mottled, bluish or pale appearance;
  • a rash that does not fade when pressed;
  • lethargy/difficult to wake;
  • abnormally cold to touch.

In children under 5, it is also important to be aware if a child is not feeding, is vomiting repeatedly or has not passed urine or had a wet nappy for 12 hours.

What are the signs and symptoms of sepsis in adults?

The UK Sepsis Trust has provided the following guidance on the signs and symptoms of sepsis:

  • Slurred speech or confusion;
  • Extreme shivering or muscle pain;
  • Passing no urine (in a day);
  • Severe breathlessness;
  • It feels like you’re going to die;
  • Skin is mottled or discoloured.

Failure to recognise the signs of sepsis and provide appropriate and timely treatment can be fatal. If you have lost a loved one and have concerns that there may have been a delay in diagnosing and treating sepsis, we can discuss your concerns further and what may be achieved by pursuing a claim.

As solicitors who regularly work alongside families who have lost loved ones, we know that whilst bringing a legal claim cannot change what has happened, it may be a way to obtain information about the treatment the loved one received. And in certain cases, we can help with the inquest process. Where dependent family members have been left without a parent or spouse, compensation can be used to meet ongoing childcare costs, compensate for financial losses and help provide for the future of the family.

Landmark court ruling: Confirmation that mother of brain-damaged baby is primary victim

YAH v Medway NHS Foundation Trust [2018]

Richard Money-Kyrle represented the mother of a 5-year-old girl who was brain damaged at birth, in her own claim for the psychiatric injuries she suffered as a mother to the injured child during and after the negligently managed labour.

Whilst the NHS defendant admitted liability for the child’s severe injuries, they contested the mother’s own claim, which Richard successfully took to trial.

The circumstances of the case

The baby’s delivery had been negligently delayed for several hours when the maternity staff failed to take a fetal blood sample to check the baby’s condition after the CTG monitor showed abnormalities in the fetal heart rate. If they had carried out the blood test the result would have prompted an urgent caesarean section which would have saved the baby from two hours of further chronic partial oxygen deprivation and acute hypoxic ischaemia in the final minutes before birth. The baby suffered cerebral palsy and is severely disabled. She has epilepsy, visual impairment, feeding difficulties, significant learning disabilities and will be totally dependent on others for all her needs throughout her shortened life.

Her mother was aware that something was wrong when her baby was born in poor condition and was taken to the special care baby unit for therapeutic cooling and intubation. She saw her baby for the first time, the day after delivery, in a box, surrounded by medical equipment, tubes and monitors, but wasn’t allowed to hold her. She was told that her baby might not survive. Then over the next few months as she gradually realised the severity of the injury that had been done to her child during the labour, she developed a psychiatric injury.

Why has this case attracted so much attention?

The case attracted the interest of the media and the legal profession because it confirmed that the mother whose unborn child was injured as a result of negligence was a ‘primary victim’. Legally, she and her unborn child were one entity at the time that the negligence occurred. She didn’t lose her status as a primary victim when the baby was born and when the combination of the difficult labour, the worry of not knowing whether her baby would survive, and the strain of looking after the severely disabled child caused her to suffer a psychiatric injury.

Why is it important that the mother was a ‘primary victim’?

The defendant argued that the mother was not a ‘primary victim’ when she suffered the psychiatric illness during the baby’s infancy.

If the mother was not a primary victim, then unless she had also suffered physical injury, she would only succeed in her claim for compensation for her psychiatric injury if she could prove that it had been caused by ‘shock’ from witnessing the negligent events, as ‘secondary victims’ are required to do by law. Although our client’s experiences during and after labour were shocking and traumatic, they did not constitute the ‘nervous shock’ that is needed to satisfy the criteria for recovery of damages by secondary victims, as set out by the House of Lords in the Alcock v Chief Constable of South Yorkshire case (which concerned the psychiatric injuries suffered by witnesses of the Hillsborough disaster). Therefore, for our client to be entitled to compensation, it was important that she was found to be a primary victim. If the mother of the unborn child who was injured as a result of the negligently managed labour was merely a ‘secondary victim’, in these circumstances she would not have been entitled to compensation for her own psychiatric injury.

The trial judge awarded our client just under £76,200 for her injury.

If you are caring for a child with cerebral palsy or other birth-related neurological disability, contact us by email on claimsadvice@boyesturner.com.

Delay in diagnosing spinal tumours - Do I have a claim?

Spinal injuries have a devastating effect on lives. At a distressing time, our specialist spinal injury lawyers can offer straightforward and clear advice and assistance. Our approach is to work with our client and their family as necessary to ensure maximum compensation to help rebuild their lives.

What is a spinal tumour?

There are a range of different tumours which can affect the spinal cord including meningiomas and schwannomas. There are also other tumours which can affect the bones around the spinal cord such as Ewing’s sarcoma.

Surgery to remove a spinal cord or spinal bone tumour is usually the first line of treatment but it may also necessary to have radiotherapy and/or chemotherapy depending on the type of tumour. We obtained a six figure sum in compensation for a 17 year old boy following a delay in diagnosis of a Ewings sarcoma tumour of the spine.

Do I have a claim?

Our spinal injury claim specialists have helped clients who have experienced delays in diagnosis of a spinal tumour, resulting in a delay in treatment of their cancer. Delays in treatment can occur as a result of misinterpreting scans or a failure to investigate the symptoms of spinal cord compression, as well as other reasons.

Early diagnosis and treatment is essential for spinal tumours. The longer a tumour is present and pressing on the nerves in the spine, the more extensive any neurological symptoms will be and it will become less likely that a person will make a good recovery. In some cases, earlier treatment of the cancer by even a few hours or days can make a difference to recovery.

Where someone has experienced a delay in diagnosis of a spinal tumour, it is necessary to establish what injuries have been caused as a result of a delay in diagnosis and treatment of their cancer.

Demonstrating the extent of the damage caused by a delay can be challenging. In cases involving spinal tumours, even with an earlier diagnosis and treatment, often surgery is necessary to relieve any pressure on the nerves in the spine. Different tumours also grow at different rates. If a tumour is slow growing, it could be present for some time before any symptoms become apparent and some nerve damage could have occurred before the point of any potentially negligent treatment.

How we can help

Spinal tumours press on the nerves in the spine and this can result in neurological symptoms. The symptoms can vary depending on where the tumour is on the spine and the period of delay. The symptoms can include altered sensation such as numbness and pins and needles in the arms and hands and legs and feet. Tumours affecting the lower part of the spine can cause bladder and bowel dysfunction.

Following treatment there is a significant period of readjustment and adaptation to ongoing symptoms such as mobility issues. Compensation can help to provide therapies during rehabilitation, private care and specialist aids and equipment which may include assistive technology.

Complications arising from the treatment of spinal tumours can also occur for non-negligent reasons. If you would like to discuss whether you have a potential claim for medical negligence, we can assist you with this and advise whether you may be entitled to compensation which could help with your rehabilitation and recovery.

All #AGloHa for Child Brain Injury Trust

Over the last week, the staff at Boyes Turner Solicitors have been supporting #GloWeek and raising funds in support of the Child Brain Injury Trust. 

As the autumnal evenings draw in, the Child Brain Injury Trust (CBIT) work to highlight the message; “Be seen not hurt”

It is important to educate primary school age children across the UK about the need to stay safe on the roads, given that they will be making their way to and from school in darker conditions at this time of year. 

On Tuesday last week staff, friends and family took part in a #GloZumba event donning fluorescent clothing, fluorescent face paint and waving glow sticks whilst completing an hour-long fitness session. We would like to thank Vodka Revolution for providing a venue for the event, and our fitness instructor from Buzz Gyms for donating her time and giving us a great workout to some very Latin beats! 

On Thursday, solicitors from Boyes Turner’s medical negligence and personal injury claims teams, together with Partner, Laxmi Patel, and her colleague, Janata Ali, from the Special Educational Needs Team attended the #AGloHa event organised by @CBIT to raise funds to help children and families affected by brain injury.

The Child Brain Injury Trust provides invaluable help for parents and families of those affected by an acquired brain injury. They offer a child and family support service, as well as advice and information and online referrals to other organisations that can help support those affected by a brain injury.

Boyes Turner’s brain injury solicitors know that when a childhood brain injury strikes, the whole family is affected, as their entire way of life is irrevocably altered. The road to recovery can seem like a long and bumpy journey.

Boyes Turner are proud to participate in the Child Brain Injury Trust’s efforts to help brain- injured children and their families access invaluable advice and support at what is, for everybody in the affected family, a very difficult time.   

To read more about the work that Boyes Turner specialist solicitors do to help those with a brain injury please click here.

Vaginal birth after caesarean section (VBAC) - risks of rupture and RCOG recommendations

The RCOG Each Baby Counts programme’s recent report into the anaesthetic care which contributed to the serious brain injury, neonatal death and stillbirths suffered by 49 babies in 2015 highlights some of the highest risk areas in maternity patient safety. Aside from the essential teamwork, communication and forward planning which is needed to handle the multiple, time-sensitive, emergencies which occur in maternity units, the report emphasised that trial of vaginal birth after a previous caesarean (VBAC), if incorrectly counselled, undertaken and managed can result in uterine rupture, severely brain damaging the fetus and threatening the life of mother and baby. 

Serious injury was caused to a baby when signs of uterine rupture (including maternal tachycardia, breakthrough pain between contractions and a worrying CTG trace) were missed during a trial of VBAC labour. Despite these warning signs, the mother was incorrectly given syntocinon, a uterine stimulant, increasing the stress on her uterine scar. The report reiterated that pain breaking through a previously effective epidural in a woman with a history of uterine surgery must always trigger an obstetric review for scar rupture.

What are the risks of VBAC compared with a planned repeat caesarean section (ERCS)?

Assuming that delivery takes place at or after 39 weeks gestation in circumstances suitable for VBAC:

  • Planned VBAC has a 1 in 200 (0.5%) risk of uterine rupture, compared with 2 in 10 000 (0.02%) in a previously unscarred uterus. The risk increases when VBAC delivery is induced or labour is augmented with syntocinon.
  • The success rate for planned VBAC is 72-75% but increases if the mother has had a previous vaginal or successful VBAC delivery. If VBAC delivery is successful, it has fewer complications than ERCS.
  • Unsuccessful VBAC resulting in emergency caesarean section carries the greatest risk of adverse outcome.
  • The risk of unsuccessful VBAC and caesarean section increases if VBAC labour is induced or augmented.

Who is suitable for VBAC?

The RCOG guidelines for VBAC list the circumstances most suited to VBAC:

  • Singleton pregnancy (i.e. expecting one baby)
  • Cephalic presentation (baby is head down)
  • Pregnancy at 37 weeks or more
  • Single previous LSCS (lower segment caesarean section - scar across the lower part of the abdomen)

A successful VBAC delivery is more likely where the mother is taller, younger than 40, and has a BMI below 30, and the labour starts spontaneously before 40 weeks, and the baby is in vertex presentation with a birthweight below 4kg.

The risk of uterine rupture during VBAC increases with the mother’s age and the baby’s gestation and size, and where the mother’s last delivery took place less than 12 months previously.

Who can’t have a planned VBAC delivery?

Planned VBAC is contraindicated where there is:

  • A history of uterine rupture
  • Previous classical caesarean scar (scar goes vertically up the middle of the mother’s abdomen)
  • Placenta praevia (i.e. the placenta’s position would obstruct a vaginal delivery)
  • The mother has a history of other uterine surgery

Who decides whether the delivery will be by VBAC or ERCS?

The choice of delivery mode must be agreed by the mother and a senior obstetrician, based on her personal risk factors, before the planned date of delivery and after she has been counselled about the risks and the circumstances in which a trial of VBAC would be abandoned and caesarean section needed. All antenatal counselling must be documented in the medical records. If ERCS is planned, an agreed contingency plan for early spontaneous labour must be written in the records.

What additional safety measures are in place during VBAC delivery?

Labour must take place in a delivery suite equipped for continuous intrapartum care and monitoring, with facilities for immediate caesarean delivery and advanced neonatal resuscitation. The fetal heart must be continuously monitored electronically from onset of regular contractions throughout the VBAC, to ensure early detection of maternal or fetal compromise, obstructed labour or uterine scar rupture. The mother’s condition and progress of labour must be regularly monitored by one-to-one care.

What are the clinical signs of uterine rupture in labour?

The three classic signs of uterine rupture are pain, vaginal bleeding and fetal heart-rate abnormalities, but in 48% of all cases the scar breaks down without any maternal symptoms and is diagnosed later during surgery.

Clinical signs associated with uterine rupture include:

  • Abnormal CTG (most common sign)
  • Severe abdominal pain, particularly if the pain persists between contractions
  • Sudden scar tenderness
  • Abnormal vaginal bleeding
  • Haematuria (blood in the urine)
  • Previously efficient contractions stop 
  • Maternal tachycardia (elevated heart rate), hypotension (low blood pressure), fainting or shock
  • There is a change in abdominal shape and fetal heart-rate not detected at the previous transducer site
  • The fetus is no longer presenting properly

Suspected rupture of the uterine scar is an emergency requiring urgent caesarean section and neonatal resuscitation as the unborn baby is deprived of oxygen, leading to permanent brain damage or death.

As specialists in birth trauma claims, Boyes Turner’s medical negligence team are experienced in helping mothers and babies affected by uterine rupture during inappropriately counselled or managed VBAC deliveries.  

If you or your baby have suffered severe injury as a result of birth-related medical negligence contact one of our specialist solicitors by email mednegclaims@boyesturner.com.

What is kernicterus?

Kernicterus is a rare but dangerous complication of neonatal jaundice in which the baby’s brain is damaged from excessive levels of bilirubin.

Bilirubin is a yellow pigment that everybody has in their blood. It is released into the bloodstream during the body’s normal process of breaking down old red blood cells.  It is processed in the liver and stored in the bile duct and gallbladder. Its function is to help the body digest fats in the small intestine, where it is known as bile, and it is then excreted along with the rest of the body’s waste. 

What is the difference between kernicterus and jaundice?

When there are excessive amounts of bilirubin in the blood and the liver is unable to process it, the first signs that the baby has excess bilirubin may include:

  • yellow discolouration of the baby’s skin
  • yellow discolouration of the whites of their eyes
  • dark staining of the urine (visible on their nappy)
  • pale chalky stools

This condition is known as jaundice and affects 60% of full term babies and 80% of premature babies during the first few days of life. Breast fed babies are at greater risk of neonatal jaundice and may suffer the effects of the condition for as long as a month.

Neonatal jaundice usually lasts up to two weeks and is usually harmless but it must be diagnosed, monitored and treated if it doesn’t resolve early to avoid the development of more serious conditions.

In addition to its own risks, jaundice can be a sign of other conditions which may need treatment, such as:

  • Infection
  • Sepsis
  • Liver disease
  • Incompatibility between the mother’s and the baby’s blood groups
  • Bruising and metabolic disorders
  • Sickle cell anaemia
  • Enzyme deficiencies

How does untreated jaundice develop into kernicterus?

When the liver is unable to process the excess bilirubin in the blood, the baby will have hyperbilirubinaemia (too much bilirubin in their blood).

Where a baby has hyperbilirubinaemia  (jaundice), their bilirubin levels must be monitored and, if rising rapidly or exceeding the threshold bilirubin levels, the baby must be treated with phototherapy. They will sometimes also need an exchange blood transfusion.

If left untreated, the toxic, unconjugated (not metabolised by the liver) bilirubin can penetrate the blood-brain barrier where it damages the brain and spinal cord, causing neurological dysfunction. This is known as bilirubin encephalopathy and its features - the pattern of damage to the brain – are known as kernicterus.

The baby may show the initial signs of kernicterus brain damage by:

  • Poor feeding
  • Failing to respond to stimulus, such as clapping hands in front of them
  • Decreased muscle tone (floppiness)
  • Seizures or fits
  • Arching of the spine

Long term disabling effects of kernicterus brain damage vary in severity but include:

  • Cerebral palsy
  • Hearing loss
  • Learning disability
  • Impaired eye movements

My baby was brain damaged by delayed treatment for jaundice – how can I find out if I can claim?

At Boyes Turner we are experts in helping children affected by severe brain damage in the birth and neonatal period. If your child has suffered brain damage from kernicterus, our specialists will be happy to advise you about whether your child has a claim arising from negligent care after your baby’s birth, or the treatment they received for jaundice either in hospital or from the community midwives in charge of their care after they were discharged home.

Legal Aid may be available if the child suffered severe neurological injury owing to negligence before or during birth or during the first eight weeks of life.

If you are caring for a child with severe neurological disability which was caused by negligent medical care of jaundice contact the team by email at mednegclaims@boyesturner.com.

Meningitis and brain injury - what can you expect?

Boyes Turner are supporting Meningitis Now’s #MayMayhem campaign in which the focus is on putting the fun into workplace fundraising to support the charity’s important work. 

Message behind the #maymayhem

Meanwhile, the message behind the mayhem is that meningitis kills. It also maims, leaving its survivors permanently disabled by limb loss and damage to the brain.

Whilst many of the physical effects of an acquired brain injury give rise to obvious disability, other consequences of the damage to the child’s developing brain can be more subtle, appearing and changing over time, making them harder to understand.

Emotional and behavioural after-effects of brain injury are often misinterpreted, particularly in a growing child or teenager. It is important for the child’s parents, wider family and school to recognise that the child may not be able to control or understand their own emotions and challenging behaviour, and to seek appropriate specialist help to support the child.

What emotional and behavioural changes can I expect following my child’s meningitis brain injury?

Meningitis Now lists some of the common difficulties that children may experience after a brain injury:

  • Tiredness leads to frustration and irritability when the child finds it difficult to return quickly to former activities or struggles to cope at school.
  • Mood swings, such as crying or laughing more quickly, temper tantrums, bedwetting and nightmares are common in the recovery period. Tiredness only makes them worse.
  • Anxiety, depression and loss of confidence come from realising that the illness has changed their life, worry about becoming ill again and coping with the long-term effects of their injury.
  • Apathy, lethargy, despondency and poor motivation can be misinterpreted as laziness, whereas they can arise from damage to the areas of the brain which affect arousal and initiation of activity. Without support, the child can slip beneath the radar at school, thereby failing to achieve their potential, and may become socially isolated.
  • Anger and aggression come from impairment of the brain’s ability to control behaviour and from frustration or struggling to cope emotionally with their injury.
  • Obsessive behaviour and lack of flexibility impede a child’s ability to adapt to different situations, including socially.
  • Disinhibition and sexually inappropriate behaviour in which the older child has no insight into the consequences of their behaviour. This exposes them to added risk of harm, causing friction with parents and teachers, and isolates them from friends who find them embarrassing.

These behaviours can arise from neurological damage to the brain impeding the child’s ability to regulate their own behaviour but also from the child’s psychological reaction to their illness and its impact on their life, their former activities, friendships and independence. Cognitive impairment makes it difficult for the child to communicate their frustration and everything is made worse by fatigue, anxiety and confusion. The child’s pre-injury personality and the dynamics and stresses within the family will also affect the child’s behaviour. Medication, such as anti-convulsants, also affect the child’s tiredness, behaviour and learning capability.

At Boyes Turner we understand that following meningitis or a brain injury the damage may go far beyond the physical. We work with educational, clinical and neuropsychologists, and child psychiatrists to assess the full effect of the injury and to secure the funding necessary to provide rehabilitation, therapy and ongoing support.

Our clinical negligence lawyers also work closely with our Special Educational Needs team to ensure that the child receives appropriate SEN assistance, whether that is in a mainstream or specialist school. By ensuring that we fully understand the child’s needs we are able to secure for them higher levels of compensation.

If you are caring for a child who has suffered a brain injury as a result of negligent medical care please contact by email on mednegclaims@boyesturner.com.

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