This is an appeal [1]
This was a tragic fatal accident claim arising from the death of “Andrew”… He had been admitted to ward A14 on 2.1.2016 with quite severe pancreatitis and was treated conservatively. He had been provided with an oxygen mask. His family had agreed with the hospital for the family to provide 24 hour supervisory care support. On 8.1.2016 he got up at night needing to go to the toilet and at just before 03.30 am, having handed his urine bottle (for measurement) to his cousin, Jonathan, he locked the cubicle door and suffered a wholly unexpected cardiac arrest. When Jonathan realised Andrew was not responding verbally he called the nurses. They arrived and (according to the notes) they unlocked the door from the outside, after some difficulty, taking 2-3 minutes. They took him out of the cubicle and tried to resuscitate him. When they failed they made a crash call at 03.38 am and the resuscitation team… Electrodes were put onto his chest. Andrew was in PEA (pulseless electrical activity of the heart, so no blood was being pumped around his body) for 25 minutes whilst they tried to resuscitate him through chest compression. Then he went into ventricular fibrillation so could (only then) give Andrew’s heart “shocks” to try to restore the rhythm. Three were delivered, alongside various heart stimulating injections, but by 04.25 am Andrew was in asystole (heart stopped beating and no electrical activity-flat lining) and so had died. [9]
Andrew’s family sued the hospital… The breaches alleged included failing to transfer Andrew to ICU. On causation C pleaded that had Andrew been given ICU high dependency treatment involving: better fluid balancing; better oxygenation; perhaps mechanical ventilation or O2 intubation, all to prevent hypoxia occurring and causing the cardiac arrest, he would have survived. It was asserted that in ICU Andrew would not have gone to the toilet without his oxygenation. If he had been better oxygenated he would have survived. The lack of oxygen caused the arrest. It was specifically pleaded that the delay in opening the door of the cubicle was not causative on C’s case. there was no mention of ECG monitoring anywhere in the Amended Particulars of Claim. [10]
D admitted that Andrew should have been cared for in ICU from 5 January 2016 , however Defendant denied causation. Defendant pleaded that Andrew had an oedematous and necrotic pancreas. He was stable on 7.1.2016. He was oxygenated properly with a mask on the ward. He could and did mobilise. He had no need for intubation or mechanical ventilation. He had no evidence of significant hypoxia. On the but for projection: whether, had he gone to the toilet from ICU, the same result would have occurred, it was pleaded that the probable cause of the heart stopping was undiagnosed arrythmia. D asserted that the crash response and result after the attack would have been the same on ICU. [11]
Breach was admitted, so the issues for the trial were:
(1) whether hypoxia caused the cardiac arrest (the Claimants’ case);
(2) whether Andrew would have been better ventilated in ICU such that the cardiac arrest would have been avoided and he would have been resuscitated.
(3) Whether heart arrythmia caused the heart attack not hypoxia. [12]
This appeal is restricted to the evidence before the lower court. [22]
I dismiss the appeal on all grounds for which permission has been granted. None of the grounds pass the test for challenging findings of fact or the Judge’s assessment of the expert or lay witnesses. [101]
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