Milk allergy death- should the book be thrown at the staff involved?

[mids2019]

....or if you are minimum wage staff member working in a stressed environment without English as a first language there should be leniency. Doctors are paid for life and death decisions but are Costa staff?

There is so much misinformation about allergies on this thread, but for those of you blaming the mother without knowing the details:

• not everyone with allergies is allowed to carry an epi pen, it's luck of the draw depending on what your allergist allows. My DD is allergic to all tree nuts, peanuts, sesame and egg yet we were told she needs to experience anaphylaxis prior to being given an epipen. Things like living in London near a hospital counted against us. Another family I know was declined an epi pen because their child doesn't have asthma as asthma makes you less likely to survive anaphylaxis.
• You are only supposed to administer the epi when there are symptoms of anaphylaxis. We don't know whether the girl was in anaphylaxis at the point the mum declined to epi.
• There isn't really such a thing as a "severe allergy" if we are talking about IgE allergies like this girl had. An allergy is just an allergy and sometimes the reaction can be severe and sometimes mild. Things like coming down with a cold or being tired can make allergic reactions worse.

I used to react to cheese. (It gave me migraine and occasionally vertigo) I once said to a server I can't have cheese. (Cheese made without cows milk was fine) I went to order something with chocolate in. To which he informed me I can't have it because of my allergy. I think after a few years I know what I can and can't eat

I gave up explaining that I couldn't have cheese after. It gets boring when a complete stranger things they know what I can and can't eat

Reading between the lines I expect this was the first time the girl had experienced anaphylaxis and it just escalated to death faster than the mum expected.

Heartbreaking and I hope she never reads this thread as she will regret not saving her DD for the rest of her life.

It seems that the EpiPen that was given was significantly delayed for various reasons (possibly including reluctance/refusal) and then a single underdose was given. She could have been given twice the dose, and that could have been repeated after 5 minutes - but perhaps even more importantly, it needed to be given earlier. That's the intervention that saves lives and sadly did not happen. I feel terrible for whatever pharmacist was involved in the underdosing because that really is a training issue. For whatever reason they lacked the confidence or feared giving "too much" adrenaline.

Unfortunately there is a lack of awareness/education around anaphylaxis. People do not understand that you can die from anaphylaxis (due to circulatory failure) without developing swelling around the mouth or breathing difficulty, for example (obviously these can also be signs of anaphylaxis but don't have to be present).

@KidsDr
One article I read said that the pharmacy staff had difficulty finding an epipen...they were out of stock as supply chains were problematic...perhaps they gave all they had, I'm not sure.

A further tragic twist is that the dentist had a severely nut allergic child herself and knew about epipens and that they did no harm if administered when not needed. However, she said she didn't think the allergy was at the stage it required a pen, she didn't think it was severe.

It's all such a tragedy and shows that more training and education is needed for those dealing with allergies on a daily basis as well as for the general public.

It doesn't matter how much the customer understands allergies really, they've disclosed one and it's a basic requirement to inform someone that has disclosed an allergy that what they've gone on to order contains that allergen, however small and however obvious that may be, because as we see from this tragic case, being clear from both sides is essential where allergies are concerned.

Yes staff can be misinformed, the training isn't that in depth and when people are ambiguous with words "I'm allergic to nuts" you don't just assume that they mean peanuts. Not suggesting that's what you did btw, but surely being over cautious is better than being blasé and making an assumption that could cost someone their life? Not everyone is going to get it right every single time because they are human, but tbh I'd rather have someone bitch at me for being over cautious than potentially kill someone, or even make them unwell. Not that that should be the only two options, because people could just be a bit more civilised about it.

@MumChp but the server has to inform them that the cheese contains lactose if they've disclosed a lactose allergy, to not do so would be seen as negligence. The server has no idea of your tolerance levels, they aren't there to make the decision for you, but they must provide the information correctly so you can make an informed decision and the responsibility for the concequences should they not do that are on them - when responsibility moves from yourself to someone else, even in part, then there needs to be an acceptance (and expectations) that they will meet that responsibility correctly and not use it as an excuse to have a pop at someone.

The customer who tried to resuscitate her also had an epipen (she had allergies of her own) but must not have known that that the pharmacist hadn't given the right dose so she didn't seem to offer it up at the time. The pharmacist said they would have definitely used the extra one if they'd known there was one.

On my previous post I thought the pharmacist was referring to the dentists epipen.

Even if a barista made a mistake, it's still not fair to hold them accountable for a customer's allergic reaction. They aren't highly paid professionals working in a hospital. There's no quiet environment, with no distractions. They are expected to multi task and often one person takes the order and someone else makes the drink - there are so many opportunities for something to go wrong.

It's reasonable to expect drs and nurses to fully concentrate on a healthcare task, with detailed medical histories in front of them and where (usually) information is checked at several stages. A min wage worker in Costa, not so much!

Did the barista make the customer aware?

Lessons have to be learned from this and food and drink takeaways need to take note and improve.

I wonder how easy it might be to accidentally use cow's milk even if the intention had been to use soy?

I suppose this is also a "problem" with calling things milk when they're not!

It's still negligence. If they've had training and didn't follow that, it's their fault.
Lots of people in minimum wage jobs have the potential to harm people if they don't do their job properly (care work, any kind of driver, working with any hazardous materials etc etc), and they should be held accountable.

I don't think there's much point in just one allergy area. People have different allergies. It would have the same problems of human error, accidental cross contamination etc as a general non allergy area, wouldn't it?

I wouldn’t have purchased a “milk” drink from anywhere if had such a serious allergy. But, if family had been going out and about for years dealing with it surely they would have expected this allergy book to be produced in Costa when milk allergy mentioned based on previous visits? Wouldn’t it be a red flag when a non-english speaking server took order and didn’t produce expected allergen book? A shame all round.

@howaboutchocolate I'd agree if their working environment was supportive, so they could concentrate on what they were doing. And if the person who takes the order, makes it and there are separate prep areas. But it's so easy to mis hear or accidentally pick up the wrong bottle of milk in a tiny kitchen area where everything is crowded on one surface. And where you are expected to serve 3 customers at a time.

I've had the wrong order loads of times in coffee shops, so I always double check at the counter. If my child had an allergy, I'd not trust a coffee shop to get this right.

Ultimately I don't think you can give people responsibility for life and death but put them in a noisy, distracting and crowded environment at the same time.

Improve to what level ? What level of training/procedure do you expect for EVERY food and drink outlet in the country and beyond? Personel responsibity for avoiding risky (and potential lethal) situations also has to be in the mix you cant throw all of the risk on the outlet.
There is a saying in risk management, ALARP (as low as reasonably possible)

There should be procedures in place to reduce mistakes. If Costa have those in place and the employee doesn't follow them, even if they're distracted, it's the employees fault surely. If Costa don't have those procedures in place, it's Costas fault. A lot of workplaces dealing with the public are noisy, crowded and distracting. Employees still have a duty of care.

Shifting the blame to customers with allergies is awful. There needs to be so much more allergy awareness in businesses that deal with food and the general public.

Training and procedures to allow them to comply with the regs that are already in place for every food and drink outlet in this country? A cow's milk drink should never have been served to someone who requested soy milk for a dairy allergy. It's just not an ok mistake to make, any more than giving customers food poisoning because you didn't wash your hands after going to the loo or not cooking chicken properly.

Food service staff are expected to know this stuff.

Every food and drink place has to have food safety and hygiene certification, why not just add more allergy training to that. It's all the same thing really, procedures around food to keep customers safe.

Individual staff are culpable. it's H&S law and has been since the 90s. This law isn't just about servers and Allergies, it covers so much more. In this situation, they need to ascertain where the fault lies, the fact that the inquest is still ongoing means that we are yet to hear about how staff are trained. Would the victim be blamed if it was any other area? There were processes and risk assessments in place, on this occasion it seems they were not fully followed, that is either the fault of the staff or the management. Let's not forget a 13 Yr old has lost their life here.

Its ridiculous to state that anyone with an allergy must not consume anything from a takeaway, every food pretty much goes through a process and people still need to eat and drink.

Exactly, best endeavours by the shop but cant eliminate all the risk

Seems Costa did have procedure in place but where they reasonable to minimise the risk ? That is for the inquest to decide.

Best endeavours by the shop but you cant eliminate all the risk unless you dont do it in the first place, like not walk into the shop (see previous message re HSE)

I couldn't disagree more.

It's something like 1 in 13 kids that have allergies. Food safety- including handling allergies - is a core part of working with food.

The fact that they are paid minimum wage is a function of the supply and demand of labour, nothing more. The UK welcomes vast numbers of unskilled immigrants which enables the UK to keep coffee shop wages down... it's not a reflection of the risks of the job.

Otherwise you may as well turn a blind eye to hospital cleaners accidentally unplugging life support machines, or care workers employing poor practices that injure patients. Low wages do not mean that it's ok to be dangerously negligent.

"best endeavours" isn't serving someone a cup full of cows milk when they've asked for something different due to an allergy. That's massively negligent. It's not like it was a trace of milk due to cross contamination. If it was, the reaction might not have been so severe.

It's pretty impossible to not allow any cows milk at all to contaminate a hot drink made on the same machine. Not unless the machine is cleaned down completely between drinks.Lots of coffee shops have notices advising this. If you have a serious allergy then don't use coffee shops.

The mum requested the jug be cleaned and bizarrely it sounds like this part did actually happen.

This wasn't a case of cross contamination, they just gave her a cup of hot chocolate made with dairy milk. Far more dangerous than a trace amount.