Mrs NB delivered her first born son at Colchester Hospital NHS Foundation Trust (CHUFT) on 11th December 2014 by caesarean section because she had developed pre-eclampsia. Following the birth Mrs NB developed refractory tachycardia (persistent, abnormally fast pulse), dyspnoea (shortness of breath) including nocturnal dyspnoea, orthopnoea (breathlessness when lying flat), peripheral oedema, reduced oxygen saturations requiring O2 therapy, basal crepitations, interstitial (pulmonary) oedema and hyperkalaemia (high blood potassium levels) that necessitated calcium chloride and diuretic therapy.
A differential diagnosis of fluid overload was made and following a positive response to a one-off administration of frusemide (40mg) the obstetric staff were falsely reassured that Mrs NB was well enough to be discharged.
A chest x-ray reviewed on 12th December 2014 had shown signs of interstitial oedema. However, because this was a portable x-ray, the heart size could not be reliably interpreted and clinical correlation and radiographic follow-up were advised but not undertaken before discharge.
On her way home just short of her front door Mrs NB collapsed and became progressively unwell over the ensuing days. Mrs NB returned to CHUFT on 16th December 2014 but despite her GP having identified worrying signs of orthopnoea, Mrs NB was discharged again and deteriorated further at home where the community services began to suspect post natal psychosis and contemplated section under the Mental Health Act.
Eventually, due to the intelligent intervention of Mrs NB’s GP blood tests were undertaken and Mrs NB was admitted as an emergency patient to CHUFT where a diagnosis of post-partum cardiomyopathy (PPCM) was made. Mrs NB was transferred to Papworth Hospital in multi-organ failure and spent many weeks in hospital receiving specialist intensive cardiological intervention.
Mrs NB has made a satisfactory recovery. A Serious Untoward Investigation (SUI) was carried out by CHUFT and potential failings were identified. It was however concluded that notwithstanding the potential failures of care the PPCM would not have been diagnosed any sooner and Mrs NB’s outcome would have been the same.
Peter Flory obtained supportive evidence from a cardiologist and ultimately unsupportive evidence from an expert obstetrician. Peter accepted that a diagnosis of PPCM was difficult to make but contended that a cardiological problem should have been identified sooner and that would have, in his mind, avoided the suspicion Mrs NB was developing post-natal psychosis with the deeply worrying concern to Mrs NB that her liberty could have been taken away.
Peter proceeded to prepare a Letter of Claim under the Pre-Action Protocol for the Resolution of Clinical Disputes and relied on the supportive findings in the cardiology evidence and the Trust’s own SUI Report. The Trust via National Health Service Resolution (NHSR) replied pursuant The Protocol with a Letter of Response (LOR) that admitted an ECG and/or Echocardiogram should have been done before Mrs NB was discharged from their care but The Trust denied this would have made a positive difference to Mrs NB; the diagnosis of PPCM being difficult to make, would not have been made any sooner and Mrs NB’s outcome would have been the same.
Undeterred, Peter felt that it was what was not said in the LOR that was telling. The NHSR had not responded at all to his argument that with pre discharge ECG and/or echocardiography a cardiac deficiency would have been diagnosed albeit the precise nature of it (PPCM) would not have been immediately apparent and the potential diagnosis of a psychiatric disorder and the threat of sectioning would have been avoided entirely. Mrs NB had developed a likely adjustment disorder as a result of her symptoms not being believed or dealt with by CHUFT in good time and because she had feared being sectioned when she had genuine physical symptoms that she felt were not being taken seriously.
Peter prepared a further letter to NHSR regarding this issue and NHSR made an offer to settle the case without any admission of fault of £7,000 but Peter advised Mrs NB to reject this. Eventually, the claim settled for £9,000 damages to Mrs NB and an agreement to pay the costs as well.