Case Studies
Delay in diagnosis of child’s brain tumour
Pauline aged 13 months developed a habit of waking crying with pain during the night. She became thin and her wasting was contrasted to her alertness. She also suffered from nystagmus an involuntary movement of the eye.
A brain tumour involving the hypothalamus and other parts of the brain was eventually diagnosed after nine months but Pauline was left with severe brain damage and complete loss of vision in one eye as a result of the delay.
Some nine months elapsed between symptom onset and eventual accurate diagnosis. When the symptoms were assessed against the available knowledge, the delay was found to have been significant and avoidable.
Medical research has established that brain tumours are among the highest causes of death and brain injury among children. It is known among doctors that for children whose brain tumour diagnosis is delayed, the risks are considerable.
Early referral to a paediatric neurologist leading to CT or MRI scanning establishes the diagnosis.
The causes of delay in diagnosis of brain tumour include investigation of the more common [less serious] causes first and doctor’s inflexibility.1
Because of rapid advances in neuroradiology, neuro-oncology, and radiation therapy, most brain tumors in childhood can be eliminated with a high chance for cure and minimal brain damage.2
In most cases of delayed diagnosis of child brain tumour no clinical negligence claim is brought because parents aren’t made aware of the avoidable nature of the delay or its consequences and so don’t consider the issue.
1Pediatrics 2008: 1, 1–12 (a case from Liverpool)
2Dr J Parker Mickle, Neorosurgeon Florida writing In the journal “Paediatric Neuro-oncology” December 1997
Case study submitted by CBIT Trustee Simon John, solicitor of Kester Cunningham John.
Brain Injury for “naughty” child pedestrians is avoidable by drivers: Jamie recovers £3.5m
Jamie was aged 7 and was playing on the pavement opposite his house in Middlesex. There was a 30 mph speed limit in force. Typically cars were parked in a line on either side of the road.
A car was driven down the road at the speed limit and Jamie suddenly ran out into its path. The driver had no opportunity to avoid the collision. So the first [non-specialist] solicitor advised his parents Jamie had no case.
Jamie had a very serious brain injury: a year later he could barely talk and couldn’t walk. His parents weren’t happy so they consulted a specialist firm a long way from home.
After they had completed their investigations it became obvious that although the collision may have been unavoidable, the injuries were not. The severe brain injuries were due to the speed of the vehicle, not the fact of the impact.
The speed (30mph) may have been permitted as a maximum for the area, but the civil law requires a commonsense approach.
In an urban area, when children are about, we know they are prone to run into the road without warning. So it is forseeable. Driving at a speed that will kill or maim when it happens is taking an unnecessary risk.
We all know the message from the Kill Your Speed campaign. Driving in those particular places 10-15mph slower may still break an arm or leg but will not cause severe brain injury.
Finally the law will not hold a child of 7 legally responsible for his own actions. So you’re left with the driver’s speed causing the injuries.
So plain was this argument to the driver’s solicitor and insurers that they didn’t even bother to fight the case. They admitted liability and made substantial interim payments that enabled Jamie to have beneficial intensive rehabilitation.
As a result he was able to walk to some extent but remained very badly brain injured. His claim was settled for £3.5m and costs.
Case study submitted by CBIT Trustee Simon John, solicitor of Kester Cunningham John.
Ten days postponement of Caesarean Section when two weeks overdue led to catastrophic injuries
Mr B's mother was two weeks overdue when admitted to hospital. Clinicians decided to deliver her by Caesarean Section electively in two days time after a weekend.
In fact the section was not performed until a week later than planned during which time the fetus suffered severe brain damage from an extended period of hypoxia.
Mr B's injuries were untypical. He had a very mild spasticity in his left arm but catastrophic cognitive injuries so that he had the mind of a toddler.
So mild was his physical injury that it was at first overlooked and caused severe causation problems. It was only on a second medico-legal examination that his very mild spasticity was diagnosed.
Mr B was over 30 years old by the time his parents brought his case to the attention of solicitors. This was not too late because he did not have the mental capacity to have brought a case himself so couldn’t be time barred for not doing so.
As required by regulation the hospital had kept the birth records.
The case was settled for £3.15M and costs.