In January 2006 C was aged 15 months… In late January she became unwell… on 23 or 24 January 2006. Initially, her condition was not sufficiently serious – a mild temperature and “a bit withdrawn” – for her parents to seek medical help. They thought it might be due to teething. On the morning of 26 January that changed. C had a temperature… At some point during the morning C’s condition worsened significantly. Her temperature rose and she became “very lethargic” and “very lifeless”. She had “glazed eyes” and a “vacant stare”. [10]
[11.50 C attended GP] recorded a history of C having been unwell for 2-3 days, that that morning she had been very lethargic and floppy, and that she had vomited three times. On examination she was lethargic and floppy and had a glazed look. Her pulse was 160-170 beats per minute… Her respiratory rate was 36… Her temperature was 40.1°C. GP noted that there was no neck stiffness or rash. He could not detect any abnormality on visual observation of her throat. In the notes he recorded his impression as “? meningococcal.” At 12.20pm he gave an intramuscular injection of antibiotics…[12]
C arrived at hospital by 1.15pm… The reason for admission was given as “pyrexia ?cause”. Her temperature was 40.4°C and her pulse 177bpm. She was described as “[a]lert but very quiet”. Oral paracetamol and ibuprofen were administered. [16]
[C was assessed by D] Impression: tonsillitis Plan: 5 days oral penicillin[22] C was discharged [23]
On 27 January C… appeared ill and lethargic. Her parents took her to the hospital for the follow up appointment… The hospital note states: “Reviewed Better… Impression: Resolving viral illness Home No follow up” [24]
C’s condition did not improve thereafter… [25]
[on 30 January] C was admitted… D formed the view that the probable diagnosis was still tonsillitis, but in the light of the deterioration in her presentation D now thought a lumbar puncture was appropriate. Bacteria were seen in the spinal fluid. This was… confirmed to be a pneumococcus. D diagnosed a partially treated meningitis. [26]
C’s condition deteriorated further… she had had a stroke… a result of the pneumococcal meningitis [27 and 28]
D diagnosis of tonsillitis was entirely reasonable based on what he saw when he examined C… he had no reason to consider any other diagnosis. However, he fell into the trap laid by the intramuscular antibiotics: he did not sufficiently appreciate that the medication that C had been given may have been masking her symptoms, and that a truer picture of her condition was that portrayed by GP. If, as he should have done, he had appreciated that then I have little doubt that intravenous antibiotics would have been administered by, at the very latest, 27 January (and, more likely, on 26 January). [130]
D is liable to C for the injuries [132]
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