ST (a Protected Party by his mother and Litigation Friend, KT) v Maidstone and Tunbridge Wells NHS Trust

JurisdictionEngland & Wales
JudgeThe Hon. Mrs Justice Swift DBE,Mrs Justice Swift DBE
Judgment Date16 January 2015
Neutral Citation[2015] EWHC 51 (QB)
Docket NumberCase No: HQ12X02550
CourtQueen's Bench Division
Date16 January 2015

[2015] EWHC 51 (QB)



Royal Courts of Justice

Strand, London, WC2A 2LL


The Hon. Mrs Justice Swift DBE

Case No: HQ12X02550

ST (a Protected Party by his mother and Litigation Friend, KT)
Maidstone and Tunbridge Wells NHS Trust

Mr Andrew Post QC and Miss Jane Tracy-Forster (instructed by Thomson Snell & Passmore Solicitors) for the Claimant

Mr Angus Moon QC (instructed by Weightmans LLP) for the Defendant

Hearing dates: 13 – 20 October and 23 October 2014

Approved Judgment

I direct that pursuant to CPR PD 39A para 6.1 no official shorthand note shall be taken of this Judgment and that copies of this version as handed down may be treated as authentic.

The Hon. Mrs Justice Swift DBE Mrs Justice Swift DBE



This is a clinical negligence claim by the Claimant, a child and Protected Party, who acts by his mother and Litigation Friend, KT. The claim concerns events which occurred at the Defendant's Pembury Hospital, Tunbridge Wells, during the period between 24 and 27 November 2004, when the Claimant was two and a half years old. He is now aged 12 years.


The Claimant suffers from at least one, and probably two, congenital haematological conditions. As a result, he was, from an early age, prone to become anaemic. The level of haemoglobin (Hb) in his blood tended to be low and required careful monitoring. Over the first two and a half years of his life, he required a number of blood transfusions when his Hb level dropped.


On the evening of 24 November 2004, the Claimant was unwell and was taken to hospital where blood samples were taken. The ensuing blood tests showed that his Hb level was very low. Nevertheless, he was not given a blood transfusion that night. Instead, transfusion began at 11.20hrs the following day.


The Defendant has admitted that, by failing to admit the Claimant to hospital on the evening of 24 November and by delaying performance of the blood transfusion until mid-morning the following day, it was negligent. The Claimant alleges that the Defendant was also negligent in that its medical staff (a) failed promptly to administer intravenous (IV) fluids when the Claimant became dehydrated and (b) gave the Claimant a diuretic drug, Frusemide (now known as "Furosemide"), during the transfusion on 25 November 2004 and also during a second transfusion which was carried out on 26 November 2004. The Defendant denies negligence in those two respects.


On 27 November 2004, the Claimant suffered seizures. He was found to have had a series of strokes, as a result of which he suffered brain damage and has been left with severe and permanent disability.


I have heard the trial of the issues of breach of duty and causation. The primary issue is that of causation, i.e. whether there was a causal connection between the admitted delay in transfusing the Claimant (together with the other breaches of duty, if proved) and the development of his strokes and consequent brain damage.


The trial necessarily focussed primarily on the detailed investigation of a number of very complex medical issues. No one involved in it could forget, however, that the events of November 2004, whatever their cause, were a tragedy for the Claimant and for his family.




During the trial hearing, the Claimant was represented by Mr Andrew Post QC and junior counsel, Ms Jane Tracy-Forster. The Defendant was represented by Mr Angus Moon QC. Counsel displayed a most impressive knowledge of the relevant medical issues and I was greatly assisted by them.

Lay evidence


Witness statements from the Claimant's parents, both his grandmothers and a great aunt were admitted in evidence. The witnesses were not called to give oral evidence since the Defendant had indicated it did not wish to cross-examine them. Their evidence related primarily to the Claimant's condition from the time when he became unwell prior to 24 November 2004 until the occurrence of his strokes.

The medical evidence


The oral evidence was from seven medical expert witnesses, who came from four areas of expertise.


Dr Martin Becker, Consultant Paediatrician, was called by the Defendant. Between 1984 and 2011, he practised at the Hinchingbrooke Hospital, in Huntingdon, Cambridgeshire. He retired in 2011, since when he has continued to act intermittently as a part-time Locum Consultant Paediatrician for the Cambridgeshire Community Services NHS Trust. He has also worked as a Clinical Teacher in Paediatrics and Child Health at Cambridge University. He has considerable experience of working with children in the context of a large District Hospital.


Evidence about the computerised tomography (CT) scans and magnetic resonance imaging (MRI) of the Claimant's brain that have been undertaken was given by two Neuroradiologists. Dr 'Kling' Chong gave evidence for the Claimant. He is a Consultant in Paediatric Neuroradiology at Great Ormond Street Hospital for Children, London, and has in the past also worked in Neuroradiology in Toronto and Philadelphia. His area of clinical expertise is the interpretation of MRI and CT scans of the paediatric central nervous system. The Defendant called Dr Wellesley St. Clair Forbes who, until his retirement from NHS practice in May 2009, worked as a Consultant Neuroradiologist at Salford Royal Hospitals NHS Foundation Trust and Manchester University Children's Hospital NHS Trust. In addition, he was a part-time Lecturer in the Department of Diagnostic Radiology at the University of Manchester. He has a particular interest in paediatric neuroradiology.


Evidence about the haematological issues was given, for the Claimant, by Dr Paul Telfer. He is an Honorary Consultant in Haematology at St Bartholomew's and the Royal London Hospital NHS Trust Hospital and Senior Lecturer in Haematology at Queen Mary, University of London. He has a specialist interest in inherited red blood cell disorders affecting children and adults, notably the congenital disorders from which the Claimant suffers. He has published widely on such disorders, in particular the congenital blood disorder, sickle cell disease (SCD), and is a member of a number of influential organisations within the field of haematology. The Defendant's witness in this field was Dr Paula Bolton-Maggs. She is a Consultant Haematologist who spent 16 years practising at the Royal Liverpool Children's Hospital, then the Manchester Royal Infirmary. Since October 2011, she has been employed as Medical Director of the UK National Haemovigilance Programme known as "Serious Hazards of Transfusion (SHOT)". SHOT is an independent body which provides data to many NHS bodies. Dr Bolton-Maggs is also an Honorary Senior Lecturer at the University of Manchester. She has a specialist interest in blood coagulation (clotting) and transfusion and has published very extensively on these subjects. She was lead author on the British Committee for Standards in Haematology Guidelines on the Diagnosis and Management of Hereditary Spherocytosis (HS), which is one of the congenital disorders from which the Claimant suffers.


Two Consultants in the field of Paediatric Neurology were also called to give evidence. The Claimant relied on Professor Fenella Kirkham, who has been a Consultant Paediatric Neurologist since 1990. From 1990 until 1999, she was Senior Lecturer in Paediatric Neurology at the Institute of Child Health, with an honorary contract at Great Ormond Street Hospital. She currently works part-time as a Consultant Paediatric Neurologist at Southampton General Hospital and also as a Reader at the University of London Institute of Child Health and the University of Southampton. She has published widely in the field of ischaemic brain damage and stroke in childhood. The Defendant's witness was Dr Finbar O'Callaghan, who is a Reader and Honorary Consultant in Paediatric Neurology based at the Institute of Child Health, with a clinical practice at Great Ormond Street Hospital. He has a research and clinical interest in paediatric cerebrovascular disease, including strokes. Both Professor Kirkham and Dr O'Callaghan are involved in work for the International Paediatric Stroke Study (IPSS).


The two Neuroradiologists had a telephone discussion ("the Joint Discussion") in February 2014, at which they addressed an Agenda of Questions agreed by the parties. Their responses to those Questions were detailed in a signed document. The other five medical experts also held discussions (which I shall refer to as "the Joint Meeting") in April 2014 and also recorded in writing their responses to the Agenda of Questions put to them. I have referred to that document as their "Joint Statement".


There can be no doubt that the medical experts have a collective wealth of knowledge and experience in what are very complex and specialist areas of medical expertise. It is common ground between them that it is impossible to know for certain precisely what happened to the Claimant's blood vessels between 25 and 27 November 2004. There is no obvious or easy answer. What the experts — in particular the Haematologists and Paediatric Neurologists — have sought to do is to form their own view as to what caused the serious brain damage to the Claimant. In reaching my conclusions as to what was the probable cause, I have had to make decisions as to which evidence I prefer on a range of relevant issues. In doing so, it is inevitable that I have to decide on occasion that the evidence of one expert is more reliable than that of another. I shall make clear when I am doing that as I deal with the various issues later in this judgment. For the present, however, there are a number of observations I should make in relation to some of the witnesses.


I found the Claimant's Neuroradiologist, Dr...

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