Velarde v Guy’s & St Thomas NHS Foundation Trust [2017] EWHC 1250 (QB) (26 May 2017)

C developed a brain injury whilst being treated by D in September 2005. He claims that this was the consequence of negligent treatment. (paragraph 1)

C was born on 9 August 2005, at 34 weeks and 5 days… (paragraph 2)

On 17 September he was admitted suffering from multiple ventricular septal defects… A standard treatment… is to postpone a surgical closure of the holes for some 18 – 24 months until the child has grown and the heart is bigger. (paragraph 3)

…in the case of an infant only a few weeks old, pending an operation in some 18 to 24 months’ time, it is common for an operation of pulmonary arterial banding to take place: a band is placed around the pulmonary artery which has the effect of restricting flow to the lungs, reducing the significant left to right flow whilst not abolishing it… (paragraph 4)

The object of treatment prior to the banding procedure was to remove this excess fluid: accordingly Cwas given diuretic drugs; inotropic drugs; and, from 20 September, Captopril. (paragraph 6)

On 21 September the operation of pulmonary arterial banding occurred. C complains about his treatment between his surgery and 28 September, on which date it became apparent that he had suffered brain injury… was the consequence of a cerebral venous sinus thrombosis… (paragraph 7)

C’s case is that the clot was caused at least in part, or contributed to, by D failure to manage his care… he was given too little fluid for too long such that he suffered a degree of dehydration as a consequence of which clotting of the blood became more likely and occurred… he was given too much Captopril, too quickly… (paragraph 8)

What is, on the one hand, “too little” and, on the other, “too much”, and what is on the one hand “over too long a period” and on the other “over too short a period” is necessarily a matter of degree… (paragraph 9)

In summary, though the regime operated was strict, and probably stricter than that in most other units, the clinical treatment of c so far as fluid restriction was concerned did not fall below the standard to be expected so as to place the hospital in breach of its duty to him. (paragraph 88)

I have considered the allegations in respect of Captopril and those in respect of fluid restriction separately, and rejected each. I have also considered whether the two should be taken in combination, and whether if so this would lead to a different conclusion. I have no sufficient evidence to suppose that it would. (paragraph 89)