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Too little, too late

01 September 2009

Dr M was working as the “duty doctor” and, during her afternoon surgery, she received a phone call from Mrs B. Mrs B was concerned regarding her ten-month-old baby son who had been screaming since early that morning. She described Baby B as hot, floppy and pale.

Dr M had a fully-booked surgery and assured Mrs B that she would visit Baby B as soon as her surgery ended. Dr M omitted to record any of the conversation in Baby B’s notes. Mrs B, when later asked, said that Dr M did not ask any further questions regarding the clinical presentation of Baby B. According to Mrs B, Dr M advised her to give paracetamol to her son in order to bring down his temperature and await review.

Dr M’s afternoon surgery continued for a further three hours, after which she drove straight to Mrs B’s house. On initial inspection, Dr M became very concerned and rang for an emergency ambulance. Baby B was floppy and unresponsive and had a temperature of 40 degrees and a widespread non-blanching rash.

His skin was mottled and he was tachycardic. Dr M wrote a letter to accompany Baby B sstating the likely diagnosis was meningococcal septicaemia, requiring urgent attention. Dr M did not give any treatment before Baby B was transferred to hospital by ambulance.

On Baby B’s arrival in the emergency department, the diagnosis of meningococcal septicaemia was confirmed and urgent antibiotic treatment was given. Following a long stay in intensive care, Baby B survived, but required the amputation of three toes and four fingers. Baby B’s parents were angry with Dr M and commenced an aggressive public campaign to discredit her. They also began legal proceedings against her.

The campaign against Dr M involved the press and Dr M gained much negative media attention. MPS was able to support Dr M in managing the negative attention she received, which was distressing and impacted on her work and home life significantly.

Expert opinion

Medical experts agreed that the long delay in starting treatment significantly impaired the outcome of Baby B. The symptoms that Mrs B had described on the telephone warranted immediate medical review. Antibiotics should have been administered once the diagnosis of meningitis was suspected.

Learning points

  • Documentation was unacceptable in this case – with no record of phone conversations, difficulties arise in assessing the decision-making process of a doctor.
  • Calls management in this case was unacceptable and practices must have agreed procedures in place for dealing with urgent calls. Significant event analysis is an invaluable test to see if the systems you have in place are working.
  • It is very difficult to assess babies or children over the phone. If there is concern or uncertainty over the severity of the child’s illness, it is important to see the patient.
  • A baby whose appearance is described as floppy or pale may be seriously ill.
  • Criticisms of a doctor in the media can be very damaging to their reputation and very difficult to deal with. Support from organisations such as MPS is often necessary.
  • A doctor’s duty of confidentiality persists even in circumstances where patients or relatives have gone to the press.
  • See the MPS publication, A guide for doctors on handling the media for advice on how to deal with media attention.
  • See also the Casebook article, Don't get caught in the rash trap.
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