Delay in treating shunt blockage leads to loss of sight
Verity was born with severe hydroencephaly (a build up of cerebrospinal fluid in the brain) and so she underwent a procedure to insert a shunt at the John Radcliffe Hospital in Oxford. Verity’s parents were warned of the symptoms to look out for in case of a blocked shunt.
Verity had significant developmental problems as a result of her hydroencephaly, including spastic quadriplegia and epilepsy. She was entirely reliant on her family for her needs, but was able to communicate by eye gaze despite some underlying visual difficulties.
It was clear that Verity was a happy child despite her significant disabilities. She loved music therapy, and enjoyed watching her family have dinner before she went to bed.
When Verity was 12, her mother noted one day that she was very sleepy and seemed to be in pain. She also had severe vomiting. She was taken to her local hospital, Northampton General Hospital, where she was assessed as having a stomach bug. After overnight observation she was discharged home.
Once home, Verity was still listless, sleepy and lethargic and she fell into a deep sleep from which she could not be woken. Her mother felt that she was exhibiting signs of shunt malfunction, and telephoned John Radcliffe Hospital. She was advised to take Verity to her local hospital in Northampton first, and they would transfer her to Oxford by ambulance.
However, the staff at Northampton did not accept that Verity was experiencing shunt malfunction and instead considered that her symptoms were due to an epileptic fit. Various neurological examinations were performed and it was initially recorded that her pupils were equal and reacting to light. However, later that evening the nurses noted that Verity’s right eye had deviated downwards and inwards.
During the night she was clearly in extreme pain, and was thrashing around her bed in a way she never had before. Again the staff considered that she was having an epileptic seizure even though Verity’s fits had never been like this before. Her mother’s pleas that this must be a blocked shunt were ignored and the Consultant on call refused to come in to see Verity.
In the morning the nurses recorded that she had a slow reacting pupil on the left, her pupils were of different sizes and they were not reacting to light. A CT scan was finally undertaken which was reported as showing appearances suggesting a shunt blockage.
Eventually John Radcliffe Hospital telephone Northampton and asked for Verity to be transferred for review of her shunt. Upon arrival she was taken to theatre for a shunt revision, but afterwards it was noted that she was not as responsive as she used to be. She was not smiling as much and her eyes were not as bright. Her family were informed that Verity had lost her sight because the optic nerves had been so badly damaged by the pressure building up due to the shunt malfunction.
As a result, Verity’s only means of communication was no longer available to her, as she had no ability to make choices with her eyes as she had done previously. She would cry persistently, and needed constant physical contact otherwise she would be inconsolable. She started to have very frequent admissions to hospital with lower respiratory tract infections, viral infections, increased respiratory secretions and seizures and the following year she sadly died following a respiratory arrest.
Expert evidence revealed that the features exhibited by Verity made shunt malfunction the most probable diagnosis, and there was an unreasonable delay in referring her to the John Radcliffe Hospital for review and revision of her shunt. It was confirmed that if her shunt malfunction had been established at an earlier stage, urgent shunt revision surgery would then have been performed which would have relieved the obstruction. This would have substantially reduced the amount of visual loss suffered by Verity.
The Trust admitted liability for the delay in recognising Verity’s shunt malfunction, and confirmed that but for the negligence, her loss of vision would probably have been prevented. This admission meant a great deal to Verity’s family, and they were pleased to learn that the Trust planned to send a letter of apology relating to Verity’s medical treatment.
With the assistance of clinical negligence Solicitor, Caroline Stokes, a five figure settlement was achieved on behalf of Verity’s estate for her pain and suffering during her final year of life.