Haywood v University Hospitals Of North Midlands NHS Trust [2017] EWHC 335 (QB) (23 February 2017)

On 17 September 2010 C gave birth… The baby was delivered by emergency caesarean section. Whilst in the hospital, C developed a persistent tachycardia: her pulse rate was measured at 130 beats per minute (“bpm”) both on the night of 18 September and early in the morning of 19 September. Testing of a sample of her blood taken at around 0825 on 19 September showed an elevated white cell count [21.5]. Later that morning her pulse rate dropped, and shortly before midday it was measured at 80 bpm, which is within the normal range. No further measurement of her pulse rate and no further blood test was carried out before she was discharged from the hospital on the afternoon of 19 September 2010… (paragraph 1)

…in the course of the caesarean section, bacteria entered the C’s surgical wound at a deep level and developed into infection… a reactive thrombocytosis subsequently developed, secondary to the wound infection: this led to C’s platelet count becoming grossly elevated and a thrombosis developing in her left carotid artery. As a result, the Claimant suffered a stroke on the 3 October 2010… (paragraph 2)

C’s case is that her tachycardia, and her raised white cell count, were caused by, and were signs or symptoms of, her developing infection. She should not have been discharged when she was. D should have considered the possibility of infection and carried out further tests. Had that been done, the results of the tests would have been abnormal, consistent with infection, and C – before being discharged – would have been given broad-spectrum antibiotics. Her infection would have been successfully treated by those antibiotics, and she would not have suffered her subsequent stroke. (paragraph 3)

D denies negligence. D’s case is that although bacteria were inoculated into C’s body on 17 September 2010, her wound infection did not develop until 21 September 2010. Her tachycardia on 18/19 September, and her raised white blood cell count on 19 September, were caused not by the infection, but by other factors related to her labour and delivery. There were no indications that further investigation was necessary, it would not have been appropriate to treat with broad spectrum antibiotics at that stage, and it was reasonable to discharge C from the hospital on the afternoon of the 19 September. (paragraph 4)

Was it negligent to discharge C from hospital at around 4.30pm on 19h September 2010 without first carrying out further tests to exclude the risk of post-operative infection? In my judgment, it was… (paragraph 124)

…reasonable care required the carrying out of further tests before C was discharged… it was wrong to dismiss 24 hours of tachycardia including several red flag readings on the basis of one pulse reading within the normal range. The tests which should have been carried out were as a bare minimum the measuring of the C’s pulse, temperature and blood pressure… (paragraph 124, xii)

…no reasonable body of doctors would have discharged C on 19 September 2010 without having carried out further tests, which I find would have shown the presence or likely presence of infection and would have led to C being given broad spectrum antibiotics which (as is common ground) would have saved her from her subsequent ill health and stroke. I therefore find that there was breach of duty on the part of D, and that C’s stroke, and its continuing consequences, were caused by that breach of duty. (paragraph 125)