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Accident and Emergency department medics work long hours under pressure – but the law still expects them to maintain reasonable levels of competence. The Court of Appeal made that point in guaranteeing substantial compensation to a teenage meningitis victim.
The girl, who was then just over a year old, had been taken to hospital by ambulance and was seen by a senior house officer (SHO). The SHO diagnosed a probable upper respiratory tract infection and the girl was discharged. However, her condition worsened and she was taken back to the hospital later the same day.
She was referred to a paediatrician, who diagnosed meningitis. She was treated with antibiotics but it was too late to save her from brain damage. She has been left with learning difficulties and is profoundly deaf. The trust that ran the hospital agreed that, had she been treated with antibiotics earlier, the infection would not have spread and she would have escaped injury. However, her damages claim was dismissed by a judge, who found that the SHO had not been negligent.
In upholding her challenge to that ruling, the Court found on the evidence that the SHO had failed to take an adequate medical history from the child's mother. In particular, she had failed to ask the obvious question of why the mother had considered it necessary to call an ambulance in the early hours of the morning. The SHO had failed to pick up on the mother's earlier statement to the ambulance crew that her child's eyes were rolling, a symptom of meningitis. The trust was found fully liable to compensate the girl and, although the amount of her damages has yet to be assessed, the award is bound to be substantial.
In its ruling, the Court noted that not every doctor can be experienced and that young doctors in particular often work all night and have to make life and death decisions. The outcome of the case should not be viewed as a reason for doctors to lose heart or abandon practice. Those who have learnt from past mistakes often have even more to offer the profession. The Court noted, however, that history taking is a basic skill which hospital doctors at all levels are expected to possess.