Nile Joseph Welds v Yorkshire Ambulance Service NHS Trust Sheffield Teaching Hospitals NHS Foundation Trust (Second Defendant)
| Jurisdiction | England & Wales |
| Judge | His Honour Judge Freedman |
| Judgment Date | 20 December 2016 |
| Neutral Citation | [2016] EWHC 3325 (QB) |
| Date | 20 December 2016 |
| Court | Queen's Bench Division |
| Docket Number | Case No: HQ13X01621 |
[2016] EWHC 3325 (QB)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
Royal Courts of Justice
Strand, London, WC2A 2LL
His Honour Judge Freedman
(Sitting as a Deputy Judge of the High Court)
Case No: HQ13X01621
(and the child's mother and litigation friend Ms Delsena Walrond)
and
Mr Simeon Maskrey QC and Mr Richard Baker (instructed by HLW Keeble Hawson LLP) for the Claimant
Miss Charlotte Jones (instructed by Browne Jacobson LLP) for the Defendant
Hearing dates: 1 – 4 November 2016
Introduction
On 13 th February 2000, Delsena Walrond (to whom I shall refer as "mother") gave birth to a baby boy, Nile Joseph Welds, the claimant, at the Northern General Hospital in Sheffield. Sadly, the claimant suffered a severe brain injury as a consequence of being exposed to a short period of acute and profound cerebral hypoxia ischemia shortly before his birth. He now suffers from bilateral dystonic cerebral palsy causing a very severe degree of impairment of his motor function, a severe degree of cognitive impairment and microcephaly.
The claimant, by his mother and litigation friend, has brought a claim for damages against the Yorkshire Ambulance Service NHS Trust and the Sheffield Teaching Hospitals NHS Foundation Trust (the first and second defendants, respectively) alleging negligence on the part of both defendants; and that such negligence materially contributed to his brain damage.
By order of Master Cook, dated 29 th July 2014, it was directed that there should be a trial of liability and causation by way of a preliminary hearing. Accordingly, this hearing is limited to the determination of issues of breach of duty and factual, as well as medical, causation.
Background
The claimant is mother's first and only child. She was born on 10 th April 1980 and became pregnant in July 1999, at the age of 19. Her pregnancy, up until a very short time prior to the birth, was uneventful. The expected date of delivery was 31 st March 2000.
On Sunday, 13 th February 2000, at about 5.30pm, mother decided to visit her mother, Dezna Ramsey (to whom I shall refer as "grandmother"). It took approximately three minutes for mother to walk from her house in Cranworth Place in Pitsmoor, Sheffield to grandmother's house in Andover Street. As mother reached the corner of Andover Street, she felt a gush of blood run down the inside of her legs. She hurried on to grandmother's house and, within seconds, she was inside.
Grandmother, immediately appreciating the seriousness of the situation, dialled 999 requesting an ambulance. The 999 call was received at 17.38 hours. Four minutes later, at 17.42 hours, the ambulance crew was activated and they arrived within three minutes, at 17.45 hours, at grandmother's house. All those timings are agreed.
What precisely occurred after the crew arrived at grandmother's house is in dispute. Suffice it to record at this stage that by 17.58 hours, that is within 13 minutes of their arrival, the ambulance left to go to the hospital with both mother and grandmother in the rear of the ambulance. The ambulance control room printout records show that the labour ward was called at 18.02.11 hours to enquire whether mother could be accepted onto the ward. At 18.03.00 hours, they confirmed that they would accept mother.
The time of arrival at the hospital had been the subject of dispute although, by the conclusion of the trial, Mr Maskrey QC, on behalf of the claimant, no longer pursued the case, at least with any vigour, on the basis of an arrival time of 18.15 hours. The latter time is to be found in the Labour Notes next to the words 'Emergency admission via 999'. It is also repeated in the Clinical Notes. However, a time of arrival of 18.15 hours simply does not accord with what appears on the electronically generated printout which reflects the time when the buzzer is pressed by an ambulance man on arrival at hospital. The arrival time is recorded as being 18.04.50 hours. True it is that on the Patient Report Form, the Ambulance Technician, Tim Morley, has noted an arrival time of 18.03 hours but I make it clear at this relatively early stage in my judgment (because timings are so central to this case) that I regard the computer printout as being the safest and most reliable way of establishing the correct time of arrival. I am satisfied, therefore, on a strong balance of probabilities that the ambulance arrived at the hospital at 18.04.50 hours.
On admission to hospital, it was appreciated that mother was suffering from a large antepartum haemorrhage (APH). The Labour Notes entry at 18.15 hours recorded that mother was 'bleeding a lot'. On any view (and the defendants do not seek to argue the contrary) mother presented as an obstetric emergency.
What transpired at hospital over a period of approximately ten minutes from the time of arrival to 18.15 hours is a matter of substantial dispute but the evidence strongly suggests that mother was in an assessment room on the labour ward by approximately 18.15 hours.
At 18.16 hours, mother was seen by an Obstetric Registrar, Dr Anthony Beardsworth, together with his Senior House Officer, Dr Taganova. He noted that she was 33 weeks pregnant and that she had had a 'large painless APH' which had started at 17.30 hours. He measured her pulse as being 120 bpm, indicating a tachycardia and consistent with a significant blood loss. In accordance with usual practice, a large bore intravenous cannula was inserted and a number of units of blood were cross-matched. Prior to doing an ultrasound scan, Dr Beardsworth's differential diagnosis was placenta praevia, that is where the placenta is either partially or wholly in the lower uterine segment. He reached this provisional diagnosis on the basis that the vaginal bleed had been reported as being painless and he found the uterus to be soft and non-tender.
The ultrasound scan, however, demonstrated a different picture. It revealed a fundal placenta and, more particularly, extreme foetal bradycardia with a foetal heart rate of 30 bpm. At this point, it was evident that mother had in fact suffered a placental abruption whereby the placenta had begun to separate from the uterine wall resulting in the foetus becoming hypoxic.
At 18.21 hours, Dr Beardsworth made a decision that the baby should be born by 'crash' lower segment Caesarean section. Mother was duly taken to theatre. The claimant was born at 18.31 hours. At delivery, there was no spontaneous respiratory effort and the claimant was immediately intubated. His Apgar score at one minute was one and four at five minutes.
The agreed paediatric expert opinion provided by Dr Richard Miles, on behalf of the claimant, and Dr Rosenbloom, on behalf of the defendants, is that the claimant suffered a total period of acute and profound hypoxia lasting in the order of 25 minutes. Although he was born at 18.31 hours, it seems likely that a further five minutes elapsed before satisfactory neonatal brain circulation was restored. On the basis of these timings, it is agreed that the profound hypoxia began at 18.11 hours. Evidence suggests that a foetus can withstand profound hypoxia for a period of approximately ten minutes without suffering permanent brain damage. Thus, the experts conclude that the claimant began to suffer irreversible brain damage at 18.21 hours.
Agreed Medical Causation
Dr Rosenbloom's analysis of causation issues as set out in his letter dated 7 th October 2016 is agreed. Thus, the position is:
i) To avoid injury entirely, the claimant would have had to have been born by 18.19 hours, in which case his circulation would have been restored by 18.21 hours. (I record that it is no longer argued on behalf of the claimant, having heard the totality of the evidence, that the claimant could and should have been delivered by 18.19 hours).
ii) Had he been born between 18.20 hours and 18.24 hours, his circulation would have been restored within two minutes of birth and he would have suffered mild, rather than very severe, disabilities. (It is now the claimant's primary case that delivery should have occurred at 18.24 hours).
iii) Had he been born between 18.25 hours and 18.28 hours, his circulation would have been restored after three minutes of resuscitation. He would have suffered moderate rather than very severe disabilities. (This is the claimant's secondary case).
iv) Had he been born between 18.28 hours and 18.31 hours, there would have been no practical difference in his level of disability.
Issues regarding Breach of Duty
In broad terms, the issues can be summarised as follows:
i) Was there a negligent failure on the part of the Ambulance Staff to appreciate the seriousness of mother's condition and its likely effect on the foetus; and the need for her urgently to be taken to hospital?
ii) In any event, was there unnecessary and culpable delay in taking mother to hospital?
iii) Was there a negligent failure on the part of the midwifery team to appreciate the seriousness of mother's condition and its likely effect on the foetus; and the need for her to be seen by an Obstetrician as soon as possible?
iv) In any event, was there unnecessary and culpable delay in requesting the Obstetric Registrar, Dr Beardsworth, to examine mother?
It will be apparent that the determination of these issues requires an analysis of two separate but short time periods: namely, the 13-minute time period from when the ambulance men arrived at grandmother's house and then departed for the hospital and the eleven minute time period between mother arriving at hospital and being seen by Dr Beardsworth.
The claimant's case is that...
To continue reading
Request your trial
-
MRA INTERNATIONAL SDN BHD vs SPC DIATECH, LLC
...materiality of a particular witness, and Welds (by his mother and litigation friend) v Yorkshire Ambulance Service NHS Trust and another 155 BMLR 101 and Re Coroin Ltd (No 2); McKillen v Misland (Cyprus) Investments Ltd and others [2013] 2 BCLC 583 that an adverse inference should not be dr......
-
Rebeccah Taylor v Chesterfield Royal Hospital NHS Foundation Trust
...in question may be considered a good explanation for not calling him or her – see e.g. Welds v Yorkshire Ambulance Service NHS Trust [2016] EWHC 3325 (QB) at [58], HHJ Freedman sitting as a Deputy Judge of the High Court: “Similarly, given that Ms Piper has no recollection of the incident ......