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You are here: BAILII >> Databases >> England and Wales High Court (Queen's Bench Division) Decisions >> DA (a child ) v North East London Strategic Health Authority [2005] EWHC 950 (QB) (19 May 2005) URL: https://www.bailii.org/ew/cases/EWHC/QB/2005/950.html Cite as: [2005] EWHC 950 (QB) |
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QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL |
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B e f o r e :
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DA (a child suing by her litigation friend and mother CA) |
Claimant |
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- and - |
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North East London Strategic Health Authority |
Defendant |
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Stephen Miller QC (instructed by Capsticks Solicitors) for the Defendant
Hearing dates: 14-18 February 2005
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Crown Copyright ©
Mr Justice Richards :
The evidence
(1) The claimant's mother, Mrs A, whose evidence provided the framework for consideration of events at the hospital on 19 March 1994. She was asked a few questions in cross-examination, by way of clarification of her evidence rather than challenge to it. I would like to pay tribute to the dignified way in which she conducted herself both in the witness box and while sitting in court throughout the trial.
(2) The claimant's father, Mr A, who attested to the pain his wife was suffering in the run-up to the caesarean section and who signed the consent form for the operation, but whose evidence was of only limited significance for the particular issues the court has to resolve.
(3) A woman, Mrs O, who had been admitted to the ante-natal ward at the hospital and who underwent a caesarean section that occupied the theatre facilities and staff at the time when the extreme emergency arose with Mrs A. Mrs O gave very brief oral evidence which was not contentious.
(1) Miss Katrina Erskine, who was at the time a consultant obstetrician and gynaecologist at the hospital. She had seen Mrs A in the ante-natal clinic but was not involved in the events of 19 March. Her witness statement was agreed.
(2) Mr Andrew Farkas, who was at the time the senior registrar in obstetrics and gynaecology at the hospital. He too had seen Mrs A in the ante-natal clinic. On 19 March he was the on-call senior registrar in obstetrics but was based at St Bartholomew's Hospital (the sister hospital to Homerton) where he did a ward round in the morning. He arrived at Homerton just after the birth of the claimant. He gave brief oral evidence which was of limited significance.
(3) Ms Audrey Crawford, the midwife in charge of the delivery suite in the early hours of 19 March. Her witness statement was agreed.
(4) Mrs Anna Peers, the midwifery sister in charge of the team of midwives at the hospital. She was on duty at the relevant time, in the role of midwifery co-ordinator. She saw Mrs A on her admission to hospital and became directly involved again in the immediate run-up to the emergency operation. She gave oral evidence. I found her a careful witness who was doing her best to assist the court, but there is one significant matter on which, as explained below, I am unable to accept her understanding of the position.
(5) Mrs Chloe Lowe, the midwife whom Mrs Peers allocated to look after Mrs A from soon after her admission until the time of the operation. She gave important oral evidence and I found her to be a sensible and credible witness.
(6) Professor Robert Poka, who was at the time an obstetric registrar at the hospital. He was coming to the end of his night duty when Mrs A was admitted on 19 March. He undertook an initial assessment of her before completing his ward round and handing over to Mr Ogueh. His witness statement was agreed.
(7) Mr Onome Ogueh, who was employed at the time as a registrar in obstetrics and gynaecology at the hospital. He was on duty as obstetric registrar at the material time on 19 March, and he carried out the operation on Mrs O and completed the operation on Mrs A. He too gave important oral evidence. He was very defensive and unduly anxious to protect himself. Nevertheless, I feel able for the most part to place weight on what he said.
(8) Dr Jacqueline Hill, who was employed at the time as the senior house officer in obstetrics. She accompanied Mr Ogueh on his ward rounds, assisted him in the operation on Mrs O and commenced the operation on Mrs A. She gave oral evidence, was a straightforward witness and accepted, in particular, the limitations on her independent recollection of events.
(9) Dr Andrew Morton, who was employed at the time as senior house officer in gynaecology. He was involved briefly in the immediate run-up to the operation on Mrs A. His witness statement was agreed.
(10) Dr Paul Sigston, who was employed at the time as the registrar in anaesthetics at the hospital. He was the only obstetric anaesthetist on call that day and acted as anaesthetist for the operation on Mrs O. He gave oral evidence which raised no significant point of contention.
(11) Dr Gary Yarwood, who was employed at the time as non-resident senior registrar anaesthetist at Homerton and St Barholomew's, covering the two sites. He acted as anaesthetist for the operation on Mrs A, having responded to an urgent call while he was doing a ward round in the intensive care unit at Homerton. He too gave oral evidence which raised no significant point of contention.
Trial of scar
The delivery of Mrs A's baby: the facts
The delivery of Mrs O's baby: the facts
The issues
(1) Mrs Lowe bleeped Mr Ogueh before he started the caesarean section on Mrs O, and at a time when the information was available which is written in the notes against 12.00. In that event the caesarean section on Mrs O should have been delayed, at least to observe Mrs A, and the consequence would have been that Mrs A's case would have taken priority and the claimant would have been delivered undamaged by 12.30.
(2) Mrs Lowe ought to have called for medical assistance before the start of the caesarean section on Mrs O, even if it is found that she did not in fact do so.
(3) Mr Ogueh ought to have gone to review Mrs A without being called, just prior to starting the caesarean section on Mrs O.
Issue (1): whether Mrs Lowe bleeped Mr Ogueh before the operation on Mrs O
(1) A normal bleep by Mrs Lowe to one of the doctors (either Mr Ogueh or, more likely, Dr Hill). This was received while the operation on Mrs O was in progress. The response, conveyed through one of the theatre staff, was that Dr Morton should be called to look at Mrs A.
(2) A bleep to Dr Morton, which resulted in his prompt attendance to look at Mrs A.
(3) A crash bleep by Mrs Peers to the obstetric team, which was received by Mr Ogueh and Dr Hill when Mrs O's baby had just been delivered. Mr Ogueh's response was to release Dr Hill from the theatre to attend to Mrs A.
Issue (2): whether Mrs Lowe ought to have called for medical assistance earlier
(1) In relation to the period 11.55 to 12.00, the joint report records Professor Bennett as feeling that certain matters "may be signs of uterine rupture viewed retrospectively but these would not necessarily have been considered as such prospectively" (emphasis added). In cross-examination he retracted "necessarily" and maintained the more emphatic view that they would not have been considered to be signs of rupture when viewed prospectively.
(2) In the case of Professor Walker, the inconsistencies went deeper, in that the joint report recorded his agreement that the trace showed no indication of a problem in any period from 11.20 to 11.55. Moreover the additional decelerations that he identified in his oral evidence as having occurred during that period were not supported by other witnesses. In particular, Professor Bennett disagreed with his identification of them. Professor Bennett also disagreed with his view that there was a rise in the baseline (as opposed to a period of increased reactivity) in the period leading up to 12.00. He pointed to an almost identical feature in the trace just after 8.30 that morning. In his view there was nothing abnormal about it. Nor, as I have said, did he consider there to be anything abnormal about Mrs A's pain or request for pethidine.
Issue (3): whether Mr Ogueh ought to have reviewed Mrs A without being called
Other matters of complaint
Conclusion