A TODDLER died at the Alexandra Hospital after doctors failed on a number of occasions to diagnose his heart condition.
An inquest at Worcestershire Coroner’s Court heard how 14-month-old Thomas Francis Duffy, who lived in Bromsgrove, had been taken to the GP several times but the condition was not picked up.
On March 19, 2011, Thomas was struggling to breathe and his parents John and Jo Duffy took him to the Alexandra’s A&E.
Mr Duffy, 39, said: “We were concerned about his chest infections but we were repeatedly told he was healthy and they were normal infections for the time of year and for a child of his age.
“That’s what was difficult for us – everytime we went to the GP they said he was a normal, healthy child and he was never referred for a routine hospital appointment.
“On the two days leading up to Thomas’ death he was seen twice by the GP and considered a thriving child but just eight to ten hours later we had to rush him to hospital with severe breathing difficulties.”
Thomas arrived in A&E at 2.37am and was originally treated for a viral induced wheeze and then for sepsis as his condition deteriorated.
Mr Duffy said after a morning of intense treatment, the family was informed Thomas was in a stable condition but an hour or so later he suffered a cardiorespiratory arrest and died at 8.55am.
Assistant Coroner John Ellery said neglect had, in part, contributed to Thomas’ death and that if the relevant treatment had been given, including the attendance of an on-call consultant paediatrician, Thomas would not have died when he did. He said there had been a ‘gross failure’ to provide basic medical attention.
The cause of death was put down to heart failure and bronchopneumonia.
To make matters worse for Mr and Mrs Duffy, they had to endure three inquests and a judicial review hearing to get the answers they were looking for.
The first inquest began on June 26, 2011, and, on the first day, the coroner concluded Thomas’ death was due to natural causes.
Kay Kelly, solicitor at Lanyon Bowdler representing the Duffy family, said: “The first inquest was listed for seven days but relevant witnesses were not called and the expert paediatrician had not worked in acute medicine for many years and could not answer the vital questions.”
She added the family brought up judicial review proceedings against the outcome which led to the coroner’s original verdict being quashed and a new one ordered.
The second inquest in December 2013 had to be adjourned after key evidence was not disclosed.
Mrs Kelly said now, three years and seven months after Thomas’ death, the family were pleased with the coroner’s verdict and hoped it would help stop a similar tragedy from ever happening again.
Lanyon Bowdler recently settled a clinical negligence compensation case against the NHS Trust on behalf of the family.
Mr and Mrs Duffy have since gone on to have a son, Luke, now two-and-a-half and Mrs Duffy is due to give birth to their third child next month.
Penny Venables, Chief Executive of the Worcestershire Acute Hospitals NHS Trust, offered their sincere condolences to the family.
“We accept the Coroner’s conclusions and we deeply regret that, in this case, we did get things wrong.”
She added in the three-and-a-half years since Thomas’ death the Trust had made significant changes to ensure the issues highlighted would not be repeated.
“The Coroner stated during the inquest that he was reassured by our actions and that lessons had been learned.
“We have offered to meet with the family to discuss the changes we have now put in place to prevent anything similar happening again in the future.”
