Medical Negligence

 

Susan Brown awarded membership of exclusive Legal 500 Hall of Fame

Congratulations to Susan Brown, partner and clinical negligence team leader, from all at Boyes Turner, for her recent induction into the Legal 500 Hall of Fame.

Susan has long been recognised by all the major legal directories as one of the UK’s leading clinical negligence lawyers, but membership of the Legal 500 Hall of Fame is awarded exclusively to partners whose expertise places them at the pinnacle of the profession and who are constantly praised by their clients for continued excellence.

Susan’s immense experience and excellent judgement in high value child brain injury and maternal injury cases resulting from birth trauma and neonatal negligence regularly results in multi-million pound compensation awards for her clients. Her professionalism and incisive astuteness have earned her the respect and admiration of her colleagues, Counsel, medical experts and opponents, but it is her compassion for the injured children and her empathetic understanding of the devastating physical, emotional and financial impact of caring for a severely disabled child which results in such close and loyal relationships with her client families.

She has dedicated her career to making a lasting difference to the lives of severely disabled children and their families. We are delighted that Susan’s outstanding expertise and commitment to achieving the best possible results for her clients have been recognised in the Legal 500 Hall of Fame.

Read more about Susan Brown and the other partners who have been recognised in the Legal 500 Hall of Fame here.

60 Seconds with... Julie Marsh shares her experience with brain injury claims cases

During Boyes Turner’s campaign to raise awareness of brain injuries, we talked to Julie Marsh, a senior associate - solicitor in the clinical negligence group, about her experience of handling claims arising from delayed diagnosis and treatment of craniopharyngioma (a type of brain tumour).

What information do you need from an individual who has concerns about delays in the diagnosis and  treatment of a brain tumour? 

I need details about the timing of the onset of symptoms, when the symptoms were first noticed and what those symptoms were.  If the patient is a child, their family might be the first to notice that something is wrong, such as a change in behaviour, difficulties with walking or with vision. It is very important that I understand how the symptoms progressed over time, whether they deteriorated or stayed relatively stable, and over how long a period of time leading, finally, to a diagnosis.

It also helps to know when, and following which medical investigations, the diagnosis was made. Various different medical investigations can take place before a brain tumour is diagnosed.  

I need to understand what treatment has been received since the diagnosis, whether further treatment will be needed in future and what information, if any, the patient or their family have been given about the long term prognosis.

Can you investigate a case even if an individual is still having treatment?

Yes.  There are good reasons for contacting a solicitor as soon as you can after suffering any severe injury through medical negligence.

There are time limits associated with bringing claims. These vary depending on the patient’s age and the severity of their brain injury.

The sooner we can establish liability, the sooner we can obtain interim payments to help pay for care, specialist equipment, therapies and other costs arising out of the negligently caused injury and to ease the financial hardship that often arises following brain injury, often long before the case is finally concluded.

It is, however, important to have a clear diagnosis of a brain tumour, as the type of tumour will determine how the tumour has developed over time and its rate of growth – some cancers grow more quickly than others - and this is relevant to the claim.  

An ongoing investigation should not affect the provision of any treatment. In one of my cases, the client’s family approached me shortly after the diagnosis of brain tumour had been made. My client needed ongoing medical reviews and went on to have proton beam therapy and further surgery to treat the brain tumour. In the meantime, we were able to establish liability for the claim.

 How are claims arising from delayed diagnosis and treatment of brain tumour funded?

This type of claim is usually funded by way of a Conditional Fee Agreement (sometimes called a ‘No Win, No Fee Agreement’) backed by after-the-event insurance. This means that there are no upfront costs to the client to get the investigation underway and that the client will not be liable for any legal costs if the investigation is unsuccessful. In a successful claim, the Defendant pays the majority of the legal costs.  

We always discuss the funding arrangements for bringing a claim with a client at the outset, so that they understand the terms of the agreement and are entirely comfortable with them before any action is taken.  

Where a claim, even if successful on its merits, will not be financially viable for the claimant, I let them know at the outset.

How do you investigate whether a GP or the hospital acted negligently?

We investigate the treatment that the patient received from their GP or their hospital doctors by reviewing their medical records, detailing the recollections of the patient and their family in witness statements, and then obtaining the opinion of medical experts on the standard of the care that was given.

In cases involving a brain tumour, presentation can include issues with vision or with balance and coordination, and if the child has been assessed by a specialist, then it would be necessary to review the records from that assessment as well.

How do you calculate the level of compensation in a case arising from delay in diagnosis of craniopharyngioma? 

The valuation of any claim is entirely tailored to the individual client, the impact of their injury on their life and their personal circumstances. Here again, we work with experts, such as occupational therapists or visual rehabilitation experts, according to the client’s needs, to explore and quantify the injury that has been caused by the negligent delay.

In brain tumour cases we sometimes have to account for the fact that some degree of brain injury may well have occurred as a result of the tumour, even if it had been diagnosed correctly at an earlier time. It takes considerable expertise to ascertain what difference the delay in diagnosis made, in terms of the injury itself and the impact it will have on the client, (such as loss of vision), and their ability to function independently in future life. We then have to translate that into the financial cost of meeting their additional needs for care, aids and equipment, specialist education (SEN) in the case of a child, and so on, along with any future loss of earnings arising from reduced ability to work.

Why do you think it’s important for cases like this to be investigated?

The consequences of any delay in treatment can be devastating for the individual and their family, whether  physically, psychologically, educationally or financially. Through interim payments and compensation settlements we can alleviate our client’s financial hardship, facilitate rehabilitation and therapies, and restore a degree of independence. 

If you or a member of your family have suffered from a brain injury as a result of medical negligence contact our specialist solicitors on mednegclaims@boyesturner.com.

Brain Injury from Subarachnoid Haemorrhage

When subarachnoid haemorrhage (SAH) occurs, usually without warning, fast action is needed to admit the sufferer to hospital for live-saving surgery. National guidelines set an accepted deadline of 48 hours from incident to surgery. Delays lead to severe brain damage, disability and death.

Effects of brain injury from SAH

A subarachnoid haemorrhage causes damage to the brain, both from the dramatic reduction in blood supply (and oxygen) which follows the rupture of a blood vessel and from the pressure on the brain caused by the aneurysm or tumour which caused the haemorrhage and the bleeding into the subarachnoid space.

A patient with SAH remains at risk of further complications following their initial haemorrhage:

  • Rebleeding can occur soon after the first haemorrhage when the healed aneurysm ruptures again, exposing the patient to a high risk of permanent disability or death. This complication can be prevented by surgical repair to the aneurysm immediately after the first SAH.
     
  • Cerebral ischaemia from vasospasm - narrowing of the blood vessels in spasm - reduces the  blood supply to the brain, leading to increasing drowsiness and coma. The risk of secondary cerebral ischaemia can be reduced by medication given after the initial SAH.
     
  • Hydrocephalus - a build-up of fluid on the brain – can cause brain damage from increased intra-cranial pressure. Patients with hydrocephalus may experience headaches, vomiting, blurred vision and difficulty walking. Hydrocephalus is common after SAH has disrupted the production and drainage of CSF and may need treatment with a lumbar puncture or the temporary insertion of a shunt to facilitate drainage of the excess fluid from the brain. 

Patients who survive a subarachnoid haemorrhage may be left with long term effects from the damage to their brain. Depending on the severity and location within the brain of their SAH, they may have:

  • epilepsy (in 5% of SAH survivors )
  • cognitive dysfunction causing difficulties with memory, planning and concentration, which can affect even the simplest of tasks
  • extreme tiredness
  • headaches
  • problems with sleeping
  • weakness and loss of sensation in their arms and legs
  • difficulty distinguishing between hot and cold, which affects their ability to shower and carry out other activities safely
  • impairment to their sense of smell and taste
  • visual impairment, such as blurred or double vision, blind spots or black spots
  • difficulty understanding speech
  • emotional and psychological problems, ranging from depression to PTSD

How Boyes Turner can help

Where surgical treatment of SAH has been unacceptably delayed leading to additional severe brain injury and consequent disability, our experienced specialist brain injury team work hard to ensure that the full extent of our client’s additional injury and the impact on their life is properly assessed, rehabilitated, and compensated.

We work with trusted medical experts to assess whether the standard of care that the individual received from ambulance, accident and emergency and neurosurgical teams met acceptable standards for this emergency condition and whether early opportunities to identify and reduce the patient’s risk of cerebral aneurysm rupture were acted upon by those responsible for their earlier healthcare.

Once liability is established, we secure early interim payments to get rehabilitation and therapies underway, and to help pay for care, home adaptations and specialist equipment. We recognise the need for early intervention to optimise recovery from brain injury. Where our client was the major breadwinner, early interim payments can sometimes be obtained to ease the financial hardship that comes with being unable to return to work following a serious brain injury.

We then work with a range of experts, according to the circumstances of each individual’s case, including care and case managers, physiotherapists, occupational therapists, speech and language therapists and psychologists to assess the extent and lifelong impact of the individual’s brain injury and loss of function and to value their consequent needs. Our clients’ settlements are structured to provide optimum security and flexibility through tailor-made combinations of lump sum and index-linked annual payments (PPOs).

In cases where negligent medical care of a patient with SAH has led to their death, we support the deceased’s dependent family members in securing compensation for their loss.

If you are caring for someone who is suffering from the results of a delay in treatment of a subarachnoid haemorrhage due to medical negligence contact one of our brain injury solicitors - email mednegclaims@boyesturner.com.

Subarachnoid haemorrhage - a medical emergency

Subarachnoid haemorrhage (SAH) is a medical emergency. Fast admission to hospital for surgery is critical as any delay in surgical treatment can result in severe brain injury or death. Mortality and morbidity rates are high: 30% of people who suffer a SAH die within 24 hours; overall, around half of all cases of SAH result in death; and those who survive can experience long-term disability from brain damage. Getting It Right First Time’s (GIRFT) recent report into cranial neurosurgery highlighted surgery for SAH as one of the most time-critical procedures undertaken by cranial neurosurgeons. It is also one of the areas in which the GIRFT team found that critical delays in admission for surgery are putting patients’ lives at risk.

What is subarachnoid haemorrhage (SAH)?

A subarachnoid haemorrhage (SAH) is a type of stroke caused by bleeding into the subarachnoid space between the membranes on the surface of the brain. It is often, but not always, caused by a cerebral (brain) aneurysm – a bulge in a weakened area of a blood vessel – which ruptures and bleeds into the area surrounding the brain. SAH often occurs without warning but can sometimes follow activity which involves physical effort or straining.

Cerebral aneurysms are often symptomless until they rupture but can sometimes be detected before rupture if the patient starts experiencing symptoms, such as visual problems, pain on one side of the face or around the eye or persistent headaches, from pressure on the brain caused by the (unruptured) bulge in the blood vessel. If an aneurysm is detected before it ruptures, surgery is often recommended to prevent rupture leading to SAH.

Cerebral aneurysms are hard to predict or prevent but the following may increase an individual’s  risk: 

  • smoking
  • high blood pressure
  • excessive alcohol consumption
  • a family history of the condition
  • other rare conditions including autosomal dominant polycystic kidney disease (ADPKD)

Less common causes of SAH include:

  • abnormal development of blood vessels 
  • brain tumour (either cancerous or benign) causing damage to the blood vessels
  • brain infection, e.g. encephalitis
  • rare conditions which narrow or block the brain’s arteries
  • vasculitis – inflammation of the brain’s blood vessels, e.g. from infection

The symptoms of SAH:

  • sudden, agonising headache – often described as a blinding pain unlike anything experienced before, as if hit on the head
  • neck stiffness
  • nausea and vomiting
  • sensitivity to light (photophobia)
  • blurred or double vision
  • stroke-like symptoms – e.g. slurred speech or weakness on one side of the body
  • loss of consciousness or convulsions (fits)

What is the treatment for SAH?

If someone is suspected to have suffered an SAH they need to be admitted to hospital as an emergency. On admission to hospital the diagnosis of SAH will be confirmed by a CT scan. If the CT scan is negative but the patient’s symptoms suggest they have had an SAH, a lumbar puncture might be carried out to check the cerebro-spinal fluid (CSF) for evidence of bleeding into the brain.

If SAH is diagnosed or suspected, the patient will be transferred to a hospital offering cranial neurosurgery. If the haemorrhage has been caused by a brain aneurysm, surgical repair and prevention of further bleeding may take place, either by clipping – a surgical procedure involving craniotomy in which the blood vessel is clipped to prevent further bleeding - or coiling, in which platinum coils are fed into the aneurysm via a catheter inserted into a blood vessel in the patient’s groin or leg. Both procedures take place under general anaesthetic.

Medication may also be given:

  • To prevent secondary cerebral ischaemia – a complication of SAH in which brain damage occurs from reduced blood supply to the brain
  • To prevent seizures
  • To reduce sickness and vomiting

How common is SAH?

Around 6,000 people a year are admitted to hospitals in England with a subarachnoid haemorrhage. SAH is the cause of one in every 20 strokes in the UK. It can happen to people of all ages but is most common between the age of 45 and 70. Slightly more women suffer from SAH than men.

Deficiencies in medical treatment of SAH

Subarachnoid haemorrhage is a medical emergency. The recent GIRFT report into cranial neurosurgery described treatment of SAH as “one of the most time-critical procedures undertaken by cranial neurosurgeons, where bleeding from a ruptured cerebral aneurysm can cause rapid and extensive brain damage”. With SAH mortality rates of 30% within 24 hours and around half of all SAH cases leading to fatality, even a short delay in admission for surgery can be fatal. The longer the delay in treating SAH, the greater the risk of severe brain damage or death.

In 2013, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommended that the nationally-agreed standard of 48 hours from diagnosis for surgical treatment of all bleeding brain aneurysms should be met consistently and comprehensively by all health care professionals treating these patients. In doing so it recommended a move towards seven day service provision.

In June 2018, the cranial neurosurgery GIRFT team found that 10% of patients do not receive surgery for subarachnoid haemorrhage within the target of 48 hours from diagnosis. Issues raised in the report about delays in throughput and patient pathways across cranial neurosurgery nationwide, such as lack of available theatres and beds, were thought to contribute to the SAH treatment delays, with the day-of-the-week of the patient’s admission disproportionately affecting the timing of their treatment. Despite the NCEPOD’s recommendation for seven-day service provision, SAH patients receiving treatment within the 48 hour target fell to 74% for patients admitted on a Friday and 58% for those admitted on a Saturday, compared with 83% for other days of the week. 

At Boyes Turner we are highly experienced in acting for brain injured and severely disabled clients whose injury arose in whole or in part from negligent delays in their medical treatment. These cases are complex and are often contested. They require specialist handling to disentangle the extent and impact of the negligently caused injury from the patient’s outcome if correct medical treatment had been given. We work hard to secure early admissions of liability, interim payments, and ultimately the best settlements for our clients which will meet their needs for care, therapies, specialist equipment and adapted accommodation. 

Boyes Turner welcome the findings and recommendations of the GIRFT team’s report into cranial neurosurgery in the hope that genuine improvements in healthcare will reduce the number of patients unnecessarily harmed by delays in treatment for SAH. Meanwhile, we will continue to work to protect the interests of those who have already been harmed or bereaved as a result of negligent healthcare. 

If you have suffered disability or bereavement from delayed medical treatment please contact our specialist lawyers - email them at mednegclaims@boyesturner.com.

Civil Liability Bill reaches the House of Commons

The Civil Liability Bill, which will reform the way the personal injury discount rate is to be set in future, has now completed its passage through the House of Lords and has reached the House of Commons.

Civil Liability Bill amendments

The bill has undergone two amendments during its three readings in the House of Lords, both in relation to timescales. The first amendment will allow the first review of the discount rate, which will undoubtedly increase it from minus 0.75%, to begin within 90 days of the bill receiving Royal Assent without the need for a specific commencement order – a minor amendment which signals the government’s intention to expedite the first review as soon as the bill becomes law.

The second amendment extends the maximum period between mandatory ongoing reviews of the discount rate from three years to five. Justice Minister, Lord Keen of Elie, explained the proposed extension of the review period as a potential way of reducing attempts to “game the system”, in which litigants try to delay or speed up claims settlements and trials to take advantage of current or anticipated discount rate benefits.  Speaking in the House of Lords at the Parliamentary committee stage of the bill’s journey towards enactment, former Justice Minister, Lord Faulks QC, a practising clinical negligence and personal injury lawyer, also referred to an accumulation of anecdotal evidence of gaming the system which is already occurring in anticipation of the expected discount rate increase with its inevitable lowering of multipliers and damages awards. He feared that such manoeuvring will take place almost continuously if the three-year review period is maintained, leading to an increase in unsettled claims as parties apply to adjourn or accelerate hearings to coincide with more favourable discount rates. The government argued that more frequent reviews would result in smaller, incremental changes which, in turn, would remove the need for parties to ‘game the system’, but conceded an extension of the review period to five years.

Discount rate change affects seriously injured claimants

The inevitable increase in the discount rate and consequent reduction of future loss awards for seriously injured claimants will undoubtedly profit the insurance industry. The Ministry of Justice has already asked insurers for their commitment to pass on the benefit of their financial gains from the new discount rate to their customers. Whether and to what extent the insurers will do so remains to be seen. 

Sadly, Boyes Turner’s personal injury team have had recent experience of defendant insurers trying to delay settlement of serious injury claims in the hope that delays will reduce the claimant’s compensation.

In clinical negligence, NHS Resolution have not resorted to such behaviour and Boyes Turner’s clinical negligence team continue to achieve high value awards for our severely disabled clients.

The Civil Liability Bill will now make its way through the House of Commons with the potential for further amendment, before finally being enacted as law. 

If you or a family member have suffered serious injury as a result of medical negligence contact our specialist medical negligence solicitors by email: mednegclaims@boyesturner.com.

Delays in cranial neurosurgery highlighted by latest GIRFT report

The latest report to be published by Getting It Right First Time (GIRFT) reveals the deficiencies and opportunities for improvement in the way cranial neurosurgery services are provided by the NHS. In contrast to previous GIRFT reports which have focussed on learning from variation in practises between NHS Trusts, GIRFT’s cranial neurosurgery report highlights that patient pathway inefficiencies and delays are being experienced in all of the 24 NHS hospitals which perform cranial neurosurgery, to the detriment of patient care and the frustration of the neurosurgeons.

The report specifically states that it is not a call for additional financial investment. Many of its recommendations can be implemented by NHS Trusts with minimal effort yet deliver an immediate impact on surgical capacity and throughput, resulting in more procedures taking place and patients who need urgent surgery receiving it faster. Implementation of its recommendations will optimise the use of existing resources to avoid delays and cancellations, free up hospital beds, deliver a better and faster service to patients whilst saving the NHS up to £16.4 million each year. NHS Improvement’s deadline for implementation of GIRFT’s cranial neurosurgery recommendations is June 2019.

What is cranial neurosurgery?

Cranial neurosurgery is a sub-specialty of neurosurgery which covers a range of surgical procedures performed on the brain or on the nerves in the skull. It includes the care and treatment of serious conditions and emergencies, such as traumatic brain injuries, intracranial bleeding and brain tumours, where timely surgery can save lives.  

Cranial neurosurgeons also carry out elective (non-emergency) surgery, such as relieving pain caused by nerve damage, and have a key role in monitoring patients with head injury.

In England, cranial neurosurgery is carried out in only 24 NHS hospitals which, together, admit 75,000 neurosurgery patients each year. In many of these cases, the patients were admitted for investigation, such as an MRI or CT scan or for monitoring after a head injury but did not have surgery. 40% of cranial neurosurgery admissions were for emergency treatment, most commonly for cranial trauma (head injury).

Cranial neurosurgery patients often need a lengthy stay in hospital owing to the severity of their condition and the longer recovery period from highly invasive surgery. For many, their care takes place in a critical care unit followed by extended monitoring on a ward, before moving on to rehabilitation. The average length of stay for patients following non-elective cranial neurosurgery was 19.4 days. 14% of patients stayed longer than 28 days.

Areas of concern arising from the report

GIRFT found that, without exception, all 24 NHS Trusts experience patient throughput delays which the frustrated neurosurgical teams believe are preventing them from seeing more patients and treating them sooner. After their treatment, patients are staying under the care of cranial neurosurgery longer than is clinically necessary, delaying the admission and treatment of new patients and resulting in high cancellation rates of those already admitted for elective surgery. 

Two-thirds of trusts fail to meet national 18-week referral-to-treatment targets for admitted neurosurgical patients, with eight trusts treating fewer than 60% of patients within the 18 week deadline. One in ten patients with subarachnoid haemorrhage or SAH (bleeding between the membranes surrounding the brain) do not receive surgery within the target time of 48 hours from diagnosis. This is a serious failing because any delay in treating SAH exposes the patient to the risk of severe brain damage or death.  

Even where cranial neurosurgery is not urgent, unnecessary stays in hospital cost the NHS more money, take up beds that delay treatment for other people and increase distress and infection risk to the patient.

The bottlenecks are experienced at every stage in the patient’s pathway. Patients have to wait for critical care beds to become available and these may be occupied by post-surgical patients awaiting discharge because the cranial neurosurgical centre has difficulty moving the patient on to other hospitals, rehabilitation centres or discharging them to a home setting with adequate rehabilitation support. The problem is compounded for tertiary (specialist treatment) hospitals because they are contractually obliged to accept referred patients requiring a specialist cranial neurosurgical procedure, whereas district general hospitals are not, and with their own stretched bed capacity and lack of rehabilitation resources, they can be unwilling or unable to take their post-surgical patient back.

Recommendations

The GIRFT cranial neurosurgery report recommends several ways in which hospitals can improve patient pathways to reduce delays and cancellations, speed up access to vital treatment, start post-operative rehabilitation sooner and improve patient experience:

  • Admitting patients on the day of surgery rather than in advance, particularly for minimally invasive procedures which don’t need anaesthetic and surgery for some brain tumours, to free up clinical care beds for more patients.
  • Reorganising the way operating theatres are used by designating one (existing, not new) theatre for acute procedures with open slots to cater for emergency admissions. This will  avoid disruption, cancellations or delays to patients already booked for elective procedures who are currently having to make way for emergency patients with higher clinical priority.
  • Speeding up discharge from cranial neurosurgery by making commissioning changes to compel referring hospitals to take their patients back once the patient is clinically ready. The success of this depends on better integration with community services to provide adequate and timely physiotherapy, OT and other rehabilitation support.
  • Avoiding thousands of neurosurgery admissions for non-surgical procedures, such as scans and post-operative checks, and consultant time spent in communicating scan results, which could be carried out by other multidisciplinary team members in outpatients or the patient’s home by phone or video-link.
  • Combining multiple consent and pre-admission clinic appointments to reduce the number of appointments that the patient needs to attend.
  • Avoiding delays by electronic information-sharing of patients’ scans and records between district general hospitals and the cranial neurosurgery centre, to avoid patients having to undergo repeated scans or long waits to be seen by a consultant because their information is not readily available.  

The GIRFT team envisaged that freeing up consultants from many of their 20,000 appointments each year will improve the use of resources, speed up discharge, reduce admissions and increase critical care bed capacity for when it is clinically required.

Freeing up just one extra bed per NHS trust per day would allow thousands more patients to receive the care of cranial neurosurgeons each year with no additional increase in resource – a goal that GIRFT believe is possible for each of the 24 NHS Trusts to achieve.

GIRFT estimate that implementation of their cranial neurosurgery recommendations will result in improved patient experience and outcomes whilst saving the NHS £16.4 million per year.

If you or a family member have suffered serious injury as a result of medical negligence during cranial neurosurgery call our specialist medical negligence 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.

What is a neonatal brain injury and how do I claim?

What is a neonatal brain injury?

Neonatal literally means newborn. In medical terms, the neonatal period relates to the first few weeks of life. A neonate is a newborn baby. Neonatal care is the specialist care of babies – often born prematurely, unwell or who are small for their gestational age – within the first weeks of life. Neonatal care usually takes place in a neonatal unit (NNU) or special care baby unit (SCBU) or a neonatal intensive care unit (NICU), depending on the level of monitoring and treatment and breathing support that is needed.

Can I get Legal Aid for a neonatal brain injury medical negligence claim?

Legal Aid is available for birth injury and neonatal claims resulting in neurological injury where the injury was caused during the mother’s pregnancy, the baby’s birth or the first eight weeks of the baby’s life. Where our specialist brain injury lawyers believe the severely injured child has a viable claim and they are eligible for Legal Aid, Boyes Turner make a Legal Aid application on the child’s behalf.

Does my newborn baby’s admission to NICU, NNU or SCBU mean that they have a claim for negligence?

There are many reasons why a newborn baby might be admitted to a neonatal unit. Some of the more common reasons include:

  • They need help with breathing and maintaining their oxygen levels by ventilation or continuous positive airway pressure (CPAP)
  • They are at risk of hypoglycaemia and need close monitoring and help with feeding to maintain their blood sugar and nutrition
  • Their heart rate needs monitoring
  • They are at risk of kernicterus and need phototherapy for jaundice
  • They are recovering from or are receiving treatment for an infection
  • They are recovering from surgery or other treatment
  • They need therapeutic cooling after suffering HIE (hypoxic ischaemic encephalopathy - brain damage from lack of oxygen)

Premature babies (born before 37 weeks of pregnancy) or those with very low birth weights often need neonatal care as they need more support and are at greater risk of complications.

In full term babies (born after 37 weeks) who have been admitted to a neonatal unit, most admissions relate to problems with respiration, hypoglycaemia (low blood sugar), jaundice or asphyxia. NHS Improvement has identified poor treatment associated with these conditions as potential causes of greatest harm which, where causing serious neurological injury, can give rise to a claim.

In a patient safety alert in 2017, NHS Improvement said: “It is a priority for the NHS to reduce avoidable harm that can lead to full-term babies (babies born after 37 weeks of pregnancy) being admitted to neonatal units. The number of unexpected admissions to neonatal units is seen as a proxy indicator that preventable harm may have been caused at some point along the maternity or neonatal pathway.”

Perinatal asphyxia or HIE, respiratory problems from meconium aspiration during birth, kernicterus from untreated jaundice, delayed treatment of infection and neurological injury from untreated hypoglycaemia are the most common neonatal brain damage claims that we see at Boyes Turner. Our clients come to us at many stages of their child’s development - shortly after birth, in early childhood or in teenage years - depending on when the damage becomes evident. Negligent medical treatment of the newborn child can cause severe disability which lasts far beyond the baby’s first few weeks.

Neonatal brain injury can present with a wide range of features. Once the damage is done, the injured areas of the brain cannot recover and as the baby grows and develops, the full extent of the problems caused by the neonatal injury are gradually revealed. These impairments can range from near normal development to a diagnosis of cerebral palsy and can present as:

  • delayed development
  • missed early years milestones
  • behavioural problems
  • difficulties with feeding or speech
  • impaired fine motor control
  • damage to the senses
  • spasticity
  • athetosis
  • severe cognitive damage. 

If you are caring for a child who has suffered a brain injury from negligent care at birth or in the first few weeks of life, contact us by email mednegclaims@boyesturner.com.

Neonatal hypoglycaemia is a cause of brain damage - how do I know if my child has a claim?

What is neonatal hypoglycaemia?

Neonatal hypoglycaemia is a common metabolic condition in newborn babies which, if left untreated, can cause long-term brain damage and disability. Hypoglycaemia means low blood glucose or sugar. It becomes dangerous when the newborn’s blood sugar drops below safe levels, such as before the baby has established a regular feeding pattern enabling it to keep its blood glucose up in the first few days of life. 

What are the risk factors for neonatal hypoglycaemia?

Until adequate feeding is established all newborn babies are at some risk of hypoglycaemia, which is why it is part of the post-natal midwives’ job to ensure that the baby is receiving enough milk. The baby’s blood sugar is measured by a heel-prick blood test and is carried out routinely in some hospitals but should always be carried out for babies who are known to be at risk.

Those at increased risk include:

  • Newborn babies with birthweights below 2.5kg - the standard threshold level below which the baby’s blood glucose must be monitored
  • Babies with diabetic mothers
  • Babies who are small for dates with intra-uterine growth retardation (IUGR)

Regardless of birthweight or their mother’s state of health, any baby who is not feeding properly could be at risk, for example by:

  • Not waking up for feeds
  • Not sucking properly
  • Demanding feeding very frequently because they are not getting enough food at each feed

Is neonatal hypoglycaemia a medical emergency?

If acted upon quickly, neonatal low blood sugar can be corrected quickly by feeding, either by breastfeeding if that provides enough milk, by expressed breastmilk or formula milk or, if necessary, intravenously by a glucose drip.

In a review of medical negligence claims relating to neonatal hypoglycaemia, NHSLA (the NHS Litigation Authority, now known as NHS Resolution, which represents the NHS in legal claims) found that abnormal feeding behaviour was very closely associated with the condition, both as a cause and as a potential consequence of hypoglycaemia. Maternal concerns about abnormal feeding behaviour were often ignored by health professionals, missing a vital opportunity to take action to prevent hypoglycaemia before permanent damage was done to the infant’s brain.

If neonatal hypoglycaemia is severe or is left untreated, the baby’s condition will deteriorate, demonstrating other signs of illness. Neonatal hypoglycaemia with abnormal clinical signs must be regarded as a medical emergency requiring immediate action to avoid permanent brain damage and severe neurodevelopmental disability. Abnormal signs which are commonly seen with hypoglycaemia include:

  • Hypothermia (low body temperature)
  • Floppiness
  • Fitting or jitteriness
  • Infection
  • Respiratory (breathing) difficulties

Hypoglycaemia can also occur alongside and in combination with other serious conditions.

My baby has brain damage from hypoglycaemia – do I have a claim?

In its review of 25 neonatal hypoglycaemia claims which succeeded against the NHS over a ten year period at a total cost of over £162 million, NHSLA identified the most common errors in clinical care as:

  • Delays in obtaining blood glucose test results
  • Delays in taking action on a low blood glucose result
  • Delays in referring babies to the paediatrician once concerns have been identified
  • Delays in admitting babies who have been diagnosed with clinically significant hypoglycaemia to the neonatal unit (NNU)
  • Delayed administration of intravenous glucose on the NNU
  • Insufficient glucose being administered to correct the hypoglycaemia
  • Delayed attendance by the paediatrician when called by the midwife to review
  • Failing to advise the mother properly when the baby is discharged home.

Unlike asphyxial (oxygen deprivation) causes of perinatal brain injury, neurodevelopmental disability from neonatal hypoglycaemia might not be obvious to the parents in the immediate aftermath of the traumatic birth or the infant’s early childhood. Neurodevelopmental disability from avoidable neonatal hypoglycaemia might be disregarded or downplayed until the child grows and the impact of their injury later becomes evident when they struggle to cope at school.

In its review, NHSLA said it was likely that whilst the cases they knew about were those where the parents had identified potential deficits in care, it is likely that others who were harmed have not been notified to NHSLA via the litigation process.

Boyes Turner’s specialist brain injury solicitors are experienced in obtaining compensation for children and teenagers with neurodevelopmental injury from avoidable neonatal hypoglycaemia. We work with experts to ensure that, where liability for the injury is established, the extent of the injury and the impact on the individual’s mobility, cognition, education, work and independence is properly assessed to ensure that our clients are properly compensated. In addition, our special educational needs (SEN) team can help families with children affected by neonatal brain injury secure the educational support that they need for their child within the school that is right for them.

If you are caring for a child who has suffered neurodevelopmental disability from negligent medical care, contact us by email mednegclaims@boyesturner.com.

Brain Injury from Meningitis - sensory after effects

As Meningitis Now’s #MayMayhem dedicated fund raising month here at Boyes Turner comes to an end and we finish off the abundance of cakes and sweet treats on sale, and the sound of party poppers slowly fades from the kitchen, it’s worth mentioning that meningitis survivors often experience sensory impairments from the damage that has been done to their brain by this virulent disease.

What sensory damage could my child suffer after brain injury from meningitis?

Meningitis Now provides helpful information for parents about how meningitis-related brain injury might affect their child:

  • Hearing loss

The most common sensory after-effect of meningitis is loss of hearing caused by damage to the inner ear. In fact, 8% of all meningitis sufferers experience some permanent loss of hearing (sensori-neural hearing loss). Children should be offered a hearing test within four weeks of recovery from bacterial meningitis or meningococcal septicaemia as early management is essential to reduce the impact on the child’s language development.

Damage to the inner ear can also cause tinnitus and problems with balance and coordination. 10% of survivors of childhood meningitis will have ongoing difficulties with balance. Balance difficulties can occur even when the child’s hearing has not been affected. This might cause problems with delayed sitting or walking in early childhood, riding a bicycle, balancing in the dark or on uneven surfaces, or in situations such as running around a busy playground. The sufferer may have dizziness, unsteadiness or vertigo.

  • Visual problems

Following brain injury both vision and the ability to understand what is seen (visual perception) can be impaired. Visual fields (the extent of what is seen without moving the eyes or head), visual acuity (seeing at different distances) and visual perception can all be affected, as can the ability to track and  change focus, coordinate information from both eyes, or fix on a series of stationary objects quickly – an essential skill for reading. The child might experience double vision.

The child might not be aware of the extent of their visual problems or might try to ignore them, so it is important that parents report any concerns about their child’s vision following meningitis or brain injury to their doctor and ask for a specialist referral.

  • Taste, smell and touch

After damage to the brain, children may experience problems with taste and smell affecting their eating habits and exposing them to increased safety risks. They may lose the ability to identify objects by touch. Altered responses to temperature or pain exposes the child to additional risks of harm.

Where a client has sensory after-effects from meningitis-related brain injury caused by negligence, Boyes Turner’s brain injury and SEN specialists work with a range of experts, including audiologists, ophthalmologists, neurologists, physiotherapists, occupational therapists and psychologists to assess the child’s disability, facilitate rehabilitation and ensure that the child receives proper treatment, support and compensation for their injury.

If you or someone you care for are disabled as a result of negligent medical treatment for meningitis please contact our specialist team by email mednegclaims@boyesturner.com.

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