Thursday, February 05, 2009

Little girl lost both legs because of careless, lazy and incompetent NHS doctors

Jodie Cross looked on in despair as her daughter Lydia was violently sick again. She knew the two-year-old was seriously ill, but she was facing an uphill battle to prove it. Lydia had appeared unwell three days earlier, on a Friday evening. When her father Tony, a policeman, took her to see an out-of-hours doctor, he diagnosed a virus and said there was nothing to worry about. By Sunday, the little girl's condition had deteriorated. This time, a different doctor diagnosed an ear infection. 'He prescribed antibiotics, even though I said Lydia wouldn't be able to keep them down as she was vomiting repeatedly,' says Jodie. 'He said: "Yes, but they will make you feel better" - as if I was being neurotic.'

Now it was Monday morning. Lydia's temperature had soared and she was hallucinating - she thought spiders were crawling all over her body. Jodie was particularly concerned because Lydia's baby sister Millie, then seven months, had just spent two weeks in hospital, critically ill with septicaemia and suspected meningitis, although the latter was never confirmed. Jodie was terrified Lydia had caught it, too.

At 10am, she rang the Gable House Surgery in Malmesbury, near the family home in Wiltshire. 'I asked for a home visit and was told matter-of-factly: "That's not our policy." 'I was really shocked. Lydia was far too ill to go out, and I expected a doctor to be sent to such a young child straight away. I know doctors are reluctant to do home visits these days, but I wouldn't have requested one if it wasn't urgent.'

Jodie, now 39, insisted on speaking to a doctor. When a doctor she didn't know called back, she explained what had happened over the weekend. 'He was very arrogant and reluctant to come out - he wanted me to take Lydia to the surgery. I explained that her sister had just been critically ill with blood poisoning and suspected meningitis, and said that Lydia had been hallucinating and vomiting. 'But he was certain it was only a virus, and told me to call back if I was still worried.'

They struggled to keep Lydia cool with a fan and Calpol. Then, when Jodie tried to bath her, she became even more concerned. 'Lydia didn't seem able to sit up,' she says. By 2.30pm, frantic with worry, Jodie called the GP practice again and asked for an emergency appointment. There wasn't one until 4.45pm - but when Tony took Lydia, a passing nurse saw how ill she was and fetched the doctor straight away. He took one look at her and called an ambulance.

'Tony rang from the ambulance to say Lydia was really poorly. I was shaking all over because I'd told the doctors this, but they'd said it was just a virus.' In fact, Lydia had meningitis and septicaemia, and was fighting for her life. Five weeks after becoming ill, both her legs were amputated below the knee because blood poisoning had killed the soft tissue. One of the effects of blood poisoning is that blood flow is diverted away from the extremities to the vital organs, so the arms, legs, hands and feet can be starved of blood and the tissue can die. Incredibly, doctors discovered that the bacteria responsible was a different strain from the one her sister had.

What is worrying is that too often meningitis is missed: Lydia's story is one of a number of similar misdiagnoses that have made news over the past few years. Only two weeks ago, the Mail reported the case of an 11-year-old, Colette Smith, who was sent home from A&E by a doctor who dismissed her symptoms, only for her to be rushed back the next day in an ambulance. In fact, research funded by the Meningitis Research Foundation has found 49 per cent of children taken to a doctor with potentially fatal meningitis and septicaemia were sent home because the signs were missed. Now the charity has produced booklets and a CD-ROM to help doctors diagnose and treat bacterial meningitis and septicaemia earlier.

Some experts believe the poor quality of cover provided by GP out-of-hours services is partly to blame, Lydia's case also highlights the terrible consequences of the decline in the GP home visits. Although there are no official statistics, anecdotally the number of home visits is declining, admits Dr Richard Vautrey, deputy chairman of the British Medical Association's GP committee. 'Fewer patients ask for visits these days,' he says. 'They tend to get an urgent appointment instead. 'We want to see patients as quickly as possible, and the best way is often to encourage them to come to the health centre. It's much easier to examine patients properly there, because you have all the right equipment.'

The fact is, doctors often don't want to make home visits, explains Michael Summers, vice-chairman of The Patients' Association. 'Although most doctors still do home visits when needed, you do get some who are no longer interested.'

Dr Vautrey admits there are pitfalls in giving advice over the phone. 'Meningitis is notoriously difficult to diagnose in the early stages,' he says. 'It will look like a simple virus at first, but can develop dramatically within hours. If people are concerned, they should not hesitate to call a doctor back repeatedly.' As the Cross family did - but to no avail.

'When I was a child, my GP knew my parents weren't neurotic and only asked for a home visit if something was seriously wrong,' says Jodie. 'The same is true of me and Tony.' The consequences of their GP's refusal to make a home visit were horrifying. When Jodie arrived at Bristol Royal Infirmary, where Lydia had been taken, she was told her daughter had stopped breathing in the ambulance. Lydia was by now so ill that her mother wasn't allowed to see her. Her parents were told that even if their daughter survived - at this stage, the doctors were fighting desperately to save her life - she might lose not only her legs but her arms.

'My first thought was of Lydia's favourite cuddly toy, a cow called Woosie,' recalls Jodie. 'When she was tired, she held Woosie against her cheek. What would she do if she couldn't hold Woosie? How could she do anything she loved?

'When we saw her, we barely recognised her because her nose, cheeks, lips, arms and legs were dark purple and swollen. A plastic surgeon had to make slits in the skin on her legs and feet because otherwise the skin would have split, and we were warned she might lose the tip of her nose, cheeks and lips, as well as her limbs. 'It was horrific. I just held her poor, bruised hand and cried. I couldn't bear to think about what might happen to my beautiful little girl.'

Jodie visited the hospital chapel daily. 'I would sit and cry and pray. I even wrote a letter to God saying he'd let us keep one daughter, please do the same with the other.' Mercifully, on her twelfth day in hospital, Lydia was well enough to come off life support. 'Of course, we were distraught - more than Lydia herself was - when we were told she'd lose her legs,' says Jodie. 'But she was lucky to be alive.'

Five years after Lydia's illness, her family, who now live in Braunton, Devon, won a fight for compensation. The High Court heard that if a doctor had seen Lydia when Jodie first called, and sent her to hospital just an hour-and-a-half earlier, her legs could have been saved. The court ruled that given her age, deterioration and her parents' ongoing concern, Lydia should have been seen at home. The GP - Dr John Harrison - admitted that, in the circumstances, he should have visited the two-year-old, although he disputed whether it would have made a difference to the outcome.

His medical insurers agreed to settle the case on the basis of 85 per cent liability, and the family was awarded a six-figure compensation sum. This money is being held in a court trust fund to provide for Lydia's needs, including prosthetic legs. Her first pair were provided by the NHS.

However, life is still far from easy for Lydia. Now aged seven, she has to have surgery every year because the bones in the stumps below her knees still grow, forming points that have to be trimmed, otherwise they cause pain and infection. This means that every year she spends three months in a wheelchair. 'Lydia's very positive, but there are times she wishes her legs were real. A few months ago, she asked to wear her legs in bed so she could be "a real little girl" in the morning, like Millie. When she woke up in the night uncomfortable, she cried because she wouldn't be a "real little girl" after all.'

In the meantime, the couple are campaigning for more paediatric training, so healthcare workers can diagnose devastating illnesses such as meningitis and septicaemia immediately. And they are adamant about what parents should do. 'My advice is if you're worried about your child, don't assume the doctor knows best,' says Jodie. 'Pester your GP for a home visit, and if they won't come, dial 999.'

A spokeswoman for Dr Harrison said: 'He would again like to apologise to Lydia and her family for the distressing time they have had to endure over the past four years. Although he did the best he could for Lydia at the time, he now realises that he could have done more for her.' A Department of Health spokeswoman said: 'Health services locally are under a legal obligation to provide home visits for those who need them. What happened in this case is clearly unacceptable.'


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