Rajatheepan v Barking, Havering And Redbridge NHS Foundation Trust [2018] EWHC 716 (QB) (13 April 2018)

…the Claimant, was born… on 16 July 2009 (paragraph 1)

This claim relates to brain injuries suffered by the Claimant shortly after his birth. C’s mother…at the date of the birth and, it is said, at that time, spoke only a very few words of English. (paragraph 3)

This Court is only concerned with the issues of liability and causation… (paragraph 4)

C was delivered by caesarean section at 22.56 hours on Thursday 16 July 2009. At birth, his condition appeared to be good with his APGAR scores and cord blood readings being normal and there were no concerns about him by either the consultant paediatrician who examined him or the midwife who performed the new born examination. (paragraph 5)

C and his mother were discharged from the Hospital at around 21:50 hours on Saturday 18 July 2009. (paragraph 6)

The following day at about 12:40 hours, the community midwife arrived at the family home to discover that C was pale and lethargic and having not been fed since 21:00 hours the previous evening. (paragraph 7)

C was immediately transferred to the Hospital where he was described as unresponsive pale and floppy with reported seizures. Blood tests revealed raised insulin and low glucose. He was in a hypoglycaemic state and this hypoglycaemia has caused catastrophic brain injuries, leaving C suffering from cerebral palsy and with severely impaired physical and cognitive function which, it is common ground, were caused as a result of poor feeding. (paragraph 8)

The Court is therefore only required to adjudicate upon the remaining part of the claim which, put simply, relates to the discharge of C and his mother on the evening of the 18 July 2009. What is said in summary is that C’s poor feeding was attributable to D’s failure effectively to advise C’s mother on proper feeding techniques and what to do if there was poor feeding, in the light of the very limited extent of her understanding of English and, on the facts of this case, C should not have been discharged on 18 July 2009 in which case the damage would have been avoided. (paragraph 11)
D contends that C’s post-natal care before he left the Hospital was, on the face of the contemporaneous notes, routine and appropriate and breach of duty is denied. (paragraph 12)

…at the heart of this case is the extent of Mrs Rajatheepan’s understanding or rather lack of understanding of English and her ability or lack of it to communicate effectively with D’s midwives. (paragraph 90)

…consideration of whether, in all the circumstances, the decision to discharge was negligent…. during the post-natal period, C was feeding well and feeding a lot and that there was no evidence of any abnormal signs demonstrated by C prior to discharge and that if those notes are accepted as the more reliable evidence, then it was reasonable to discharge. (paragraph 96)

The reality is that no one had ever in fact given Mrs Rajatheepan a clear and understandable explanation of the importance of feeding still less as to how she should respond if she had concerns. Because of the language barrier, Mrs Rajatheepan had been unable to communicate her concerns to hospital staff and when those concerns were communicated on the parent’s behalf by [friend] they were not acted upon. Given the time at which this review should have taken place, on the balance of probabilities, I conclude that if it had taken place as it should have done C and his mother would have been kept in hospital overnight and the difficulties with feeding would have become apparent and the injuries in fact suffered would have been avoided. (paragraph 108)

…judgment in favour of C with damages to be assessed (paragraph 109)