Inquest: Countess staff should have tested Cheshire toddler for sepsis

Independent paediatric medical expert Dr Mary Montgomery told the inquest of Olly Stopforth that, by hospital guidelines in place at the time, the toddler should have been tested after his arrival at the hospital on March 20, 2020, due to his high temperature, rash, a heart rate of over 200 and rapid breathing recorded en route in an ambulance, where a paramedic also relayed she suspected sepsis.

Dr Montgomery added there were "lots of caveats" to the missed opportunities, in that hospital staff were under "desperately hard" constraints caused by the first wave of the coronavirus pandemic, with uncertainty on how to look after patients at that time and manage increased PPE.

Olly Stopforth. (Image: Family photo.)

Olly was discharged from hospital at 3am the following day, having been treated with paracetamol, Ibuprofen and Diffmel throat spray for a viral infection. He sadly died at his Bellemonte Road, Frodsham home early on March 23, found by his mum Laura Stopforth.

A post-mortem examination found the cause of Olly's death was invasive group A strep, with a secondary cause of a viral respiratory tract infection.

On the second day of the three-day inquest to be heard at Cheshire Coroner's Court in Warrington on Tuesday, January 9, paediatric registrar Kieran McCarthy fought back tears as he was shown a photo of Olly's rash, taken at 7.20pm on March 20 - several hours before he examined the toddler at 11.30pm - and said it more definitively displayed a sign of scarlet fever.

He said by the time Olly had been transferred to the paediatric ward - over five hours since his 5.30pm admission to the hospital's A&E department - he observed the rash as more extensive over the abdomen, and considered it to be a viral infection.

He told the inquest: "It may be that when I saw him then, there was more than one process going on at that time. That extensively red rash could have been masking this small one on the abdomen and led me to miss it."

Asked about his decision to discharge Olly, after one set of normal observation readings was recorded at 2am, Dr McCarthy accepted it was not his "normal practice", but he added it was at a time when it was feared keeping people in hospital for longer times put them at risk of coronavirus, and it was not yet known what the risk was to children.

He said: "At the time I felt it was the right thing to do."

Previously, the inquest heard from consultant paediatrician Alison Timmis, who assessed Olly at 5.45pm after he had been admitted with two other 'red alert' babies, potentially requiring immediate emergency treatment.

Dr Timmis said her assessment was not intended to be a "full and formal" assessment.

Dr McCarthy accepted that, even if he had been aware of this, a fuller assessment should have been done on Olly due to the delays in transferring him to the paediatric ward. He added that, as it was "an incredibly busy shift", "time had really flown" and he had not realised how long it had been since Olly was assessed.

Olly Stopforth. (Image: Family photo.)

The jury heard Olly, following Dr Timmis' assessment, was to be placed on a 'fluid challenge' where he would receive 5ml of liquid every five minutes for an hour, but this was not formally carried out.

Questioned by barrister Vanessa Cashman, for the Stopforth family, paediatric nurse Danielle Burgoyne said as Olly had taken on fluid in the past hour, and it had been "extremely busy" on the ward, her priority was to get his temperature down.

She said: "I should have done an accurate fluid balance chart."

Dr Montgomery said the hospital staff documentation did not clearly highlight certain factors such as Olly's lack of urine output for 12 hours, which was a sign he was quite sick, and that clearer documentation would have triggered screening for sepsis, as he was presenting as ill and had been 'grunting', with contributing factors of a high heart and respiration rate, plus reduced activity.

The medical expert said that would have led to blood tests or, at the very least, more frequent and prolonged observations for Olly.

The inquest heard Dr Montgomery's opinion was that, in cases of doubt, it was preferable a child would receive antibiotics for a short time (24-48 hours) if they didn't need them, than not giving antibiotics to a child who did need them.

Professor Vav Cartwright, in a written statement read out to the court, stated if a blood test had been done for Olly, it would have shown a raised white blood cell count, and an x-ray would have shown evidence of a chest infection. He added on the balance of probabilities, Olly would have required a two-week course of antibiotics, after which he would have made a full recovery. 

All Countess staff who gave evidence at the inquest over the two days so far accepted more should have been done to treat Olly, and each offered their apologies and condolences to the Stopforth family present.

The inquest, before coroner Jacqueline Devonish, is expected to conclude on Wednesday, January 10.