What is sepsis?
Sepsis is a rare but serious infection, sometimes referred to as blood poisoning or septicaemia. Sepsis occurs when the immune system cannot cope with localised infection affecting one part of the body and it spreads – putting it simply, the body goes into overdrive. It generally happens when the immune system is already weakened. Sepsis can have catastrophic consequences for a person and, sometimes, leads to death.
This is the case with or without any clinical negligence by doctors and nurses. Sometimes even with the best treatment it can still happen and cause longstanding impairment. However, there are some instances where the negligence (including delay in diagnosis and starting investigations) contributes to the poor outcome and patients have brought a claim for the financial compensation due to the ongoing physical impairment. For some patients, it results in loss of limbs and often an inability to work.
There are many causes of sepsis and this article is helpful.
Increased risk of sepsis
There is an increased risk of sepsis once a patient has undergone surgery and/or is already in hospital. There are more “tell tale signs” to look out for, not always easy when patients are recovering and often on medication so may not immediately pick up themselves. Plus. sepsis isn’t always easy to diagnose as the symptoms can sometimes appear like more generic flu like and can mirror (initially) less serious illnesses, which to the average GP may not alert them to sepsis. Plus, the symptoms can vary depending on age (babies have different symptoms to adults).
A summary of the symptoms can be found on the NHS website here.
Treatment of sepsis
The National Institute of Clinical Negligence (NICE) Guidelines 2016 outline how suspected sepsis should be treated.
There are also “sepsis six” requirements and once the sepsis has been diagnosed, these steps must be taken within one hour:
- Titrate oxygen to a saturation target of 94%
- Take blood cultures.
- Administer empiric intravenous antibiotics.
- Measure serum lactate and send full blood count.
- Start intravenous fluid resuscitation.
- Commence accurate urine output measurement
Clinical negligence in a sepsis patient
For those patients in hospital they will be at higher risk of sepsis as will be those who have recently been discharged from hospital. Imagine a situation where a patient goes to the GP with symptoms of flu and a “racing heart”, a history of recent surgery and prolonged stay in hospital. On further questioning the patient tells the GP that he feels hot (temperature is not taken) and has vomited. The GP, who is running behind in his clinic, advises the patient to rest and to take tablets for the temperature. There is no advice provided to the patient on returning if he deteriorates and/or seeking A & E if outside of the clinic hours.
The patient calls into work, saying he cannot work that day as he’s under the weather. He goes home, climbs into bed, cannot focus on the TV and turns off his phone. He deteriorates and drifts in and out of consciousness and feels disorientated. There is no one at home with him, his wife is at work so he tries to sleep it off. Sepsis has taken hold and has become serious. The window of treatment is now short. By the time his wife gets home from work, he is unconsciousness and has patches of discolouration on his legs and he is taken to A&E by ambulance. The wife was not with her husband during the day and doesn’t know what happened at the GP clinic, nor what happened to her husband during the day as he didn’t reply to her text messages asking how he was.
A&E cannot get a history from the patient nor his wife. That makes it harder. Fortunately they suspect sepsis and immediately carry out blood tests and check organ function, arranging urgent scans and IV resuscitation. Unfortunately though as it is a busy evening in the A&E department a junior doctor assesses the results. On the plus side the doctor immediately diagnoses sepsis and tells his wife there is a risk of death. There is some unfortunate delay at commencing the treatment because they were waiting for a bed to become free in the ICU.
The husband is looked after to a high standard in A&E and the wife feels very grateful. He responds to some of the treatment but a below knee amputation becomes necessary as the leg is “necrotic” which means it has been deprived of oxygen and is “dead”. He will never be able to walk again independently. He was 52 and can never return to his job as a fork lift driver on a construction site and seeks legal help in bringing a claim against his GP and the hospital for their delay at commencing treatment.
This is a hypothetical example, not precisely one of our cases but it illustrates how catastrophic sepsis can become and the importance of medics being alive to it especially when patients are in hospital already or recently discharged. It is irrelevant that the hospital doctor was junior or that the GP was rushing/running late in clinic. Had this GP taken his temperature, listened to his heart rate, asked more about the vomiting, taken on board the fact he had undergone surgery recently and provided advice on what to do if his symptoms deteriorated, the patient may have got himself to hospital before losing consciousness when the damage of the sepsis started to set-in.
And, had the hospital commenced treatment sooner (and within the one hour required from the diagnosis), it is very difficult to assess whether that would have made a difference given the way in which the patient attended hospital, to some extent the damage was already done. Even if the sepsis was treated without any negligence it may have had some consequences for the patient. The key with any such clinical negligence claim is being able to prove what difference the substandard medical treatment made, as opposed to the underlying condition of the sepsis.
To conclude, liability (legal blame) and quantum (the value of a claim) issues in sepsis clinical negligence claims are notoriously difficult. A careful analysis of the medical records, and detailed (especially an early) account of the patient and relatives (where available) will be critical. Also, selecting the correct medical experts (and ensuring they have experience of treating sepsis which is a rare condition) is an essential part to succeeding with any such clinical negligence claim.
If you or a relative would like some advice on a potential clinical negligence claim for sepsis please contact us for a free, no obligation consultation with a specialist solicitor. Whenever we can, we like to offer No Win, No Fee agreements.