To make a complaint to PALS

[ElseaKnowsBest]

Recently me and my DH took DS to hospital. He had been unwell for a few days and had deteriorated quite badly. His temperature was high, he was not eating or drinking and had gone floppy. (No wet or dirty nappies either). We had been giving him dyoralite and regular paracetamol and ibuprofen. Nothing was working and after ringing 111 we ended up in A&E. The doctor looked at his OBS said his heart rate was very high and his oxygen wasn't as good as it should have been. They wanted to observe him and needed a urine sample. 12 hours later his heart rate was a bit lower and oxygen had improved slightly. We got told it was a viral illness and to go home. "Keep doing what you're doing". I was called a paranoid mother because I said he still seemed really poorly. I asked if they could take his blood. Doctor said no. 3 days after that he was unresponsive and was rushed to a specialist hospital. We got told it was severe dehydration. My husband went with him, I dropped my DD off at school and made my way to hospital. When I got there my son was in a resuss room surrounded by doctors. His x-ray results showed he had pneumonia in his left lung. His veins had collapsed so they had drilled into his shin bone to get strong antibiotics into him as he also had sepsis in his legs. The doctor told me he was in critical condition. Once stable he was taken to the great north children's hospital. The antibiotics weren't doing enough and he had an empyema and needed surgery. The surgeon took all the infection out and he had a drain in for 4 days as they had found an abscess in his lung. 14 days in hospital and he's back home. He lost muscle mass in his legs and has had to learn to balance again.
I'm angry at the original doctor as he failed to grasp just how ill my son was. If he had taken blood he might have found the infection in his blood. My 18 month old baby nearly died! I keep thinking about it. It's put dampener on Christmas and I'm struggling. The health visitor has been lovely and has given me tips about how to build him back to a healthy weight.
AIBU to make a complaint to PALS about the first doctor? Or should I accept that limited resources and pressure on doctors meant he did all he could at the time?

YADNBU.

Definitely put a complaint in, if not just to state how angry you are with the first doctor but so that retraining can be done as it's clearly needed.

My DD has a Hickman line that can get infected (sepsis) really quickly. This happened whilst we was in hospital, her temp was sky high, she was floppy and unresponsive, I called for the nurse who also told me I was being paranoid, I kept complaining and finally a doctor was sent round to see her after 3 hours of being ignored. As soon as the dr came into the room he panicked! At this point she wasn't hardly breathing and her body had started shutting down, they nearly killed my baby!! Straight away I complained and every nurse that was on the ward that night were given extra training and posters about sepsis were in every single Bay Area and every side room. Sometimes it helps to complain!

lljkk Yes. CRP (c-reactive protein) is a simple blood marker for infection in the body, it measures the inflammation response to it. Was used to show how my father's pneumonia was developing.

Yes complain, the original doctor could've explained his reasoning for not doing blood tests rather than call you paranoid.

You can't know if the infection would've showed up at that point, but equally the hospital can't know that it wouldn't have.

Yes you should raise this. Advise PALS as you have told us and say you would like a review of the case notes and for them to talk you through it all. Your baby has had a traumatic time, as have you.

Yes, and the very fact that children can become ill v quickly is EXACTLY why this dr shouldn't have sent that child home. Just from reading this he should have at least treated for dehydration and then observed and seen if he genuinely improved. This poor child could have died from sepsis.

Go to PALS, they will instigate a complaint and a Root Cause Analysis will be done to track every single step along the way. The young lad's clinical charts will be examined and his clinical state looked at to see if the dr could have / should have been more cautious in their approach.

As Awwlook says, there are clear pathways to be followed so that assessment can be made around key clinical markers that can indicate sepsis which comes on quickly and also kills quickly as well - another reason why DC should have been kept in, not sent home.

He will get better really quickly though I'm sure - presumably he's going to have physical therapy to help with his walking and stretch his tendons out again??

I have been in a similar situation,
If you are happy with all of the other care he received, then put this in your email/letter too!
Without a complaint and hopefully an investigation into what happened - no one will ever learn from these mistakes - but as others have said, don't be surprised if you get a load of bullshit back, or get told that YOU were the one who told the Dr YOU were a paranoid mother. (that was us - turned it round like it was us in the wrong!)
Its lovely to hear that your DS is on the mend too :)

Get copies of the a and e notes too. But be prepared they don't like to give them. We had to wait MONTHS to get them and they were false so check EVERYTHING
If they are copies then ask to see originals (false info was put in ours then a name and address sticker over the real details to look like it was dds-I had to go in and physical get hold of real copy and peel the sticker off to prove notes were false as they said they had tested her and they hadn't then had made false notes to back up their story)
It can be a difficult process but hopefully your trust deals with complaints properly

If they used the words "paranoid mother" that is worth a complaint. Children change quickly and pneumonias are often secondary to an initial viral infection so they may have been right at the time but things changed. That said, it is worth feeding back and this would be treated as a significant event in which the case is revisited and analysed to see if or how things could have been done differently. It's a useful exercise for everyone involved in his care and also for you. If it is just "one of those things" it will help you get that straight in your mind. If things should have been different it helps you to know that individuals have been educated and systems changed to ensure as far as possible that it doesn't happen again.

I'm glad he's on the mend and sorry you've had such a horrible time.

Honestly, there is NO excuse. There's been massive, huge efforts in the NHS in recent years to get on top of failure to diagnose sepsis early enough that it can be treated. Even I know all about it and I'm not a clinician!

That should have been one of the things the dr was going to rule OUT and it does appear to me that the dr didn't do that.

when young or vulnerable people are in this situation like your child was, at the very least a complaint needs to be logged to ensure the Dr that called you a paranoid mother needs addressing. You are your childs voice and in your situation I would do a factual account, dates etc and leave it to be investigated.

My son was misdiagnosed at the age of 3 and luckily to my persistence that something was wrong despite the first DR saying nothing was wrong, I requested a 2nd opinion and as a result he received urgent surgery. I also received an apology from the first doctor and the other doctors at the practice had a meeting and asked me to consider taking further action against him.

I am glad your son is OK, but you have been put through a lot and this needs to be prevented from happening again to another vulnerable person

x

Complain about being called a paranoid mother , by all means.
But I think it is very difficult for doctor's to diagnose meningitis.
When my DD was 14 months, (she's nearly 20 now), she had a febrile convulsion, which wouldn't stop happening. She was rushed to hospital, and I genuinely thought she was about to die - needles and oxygen masks and straight into resus...They were concerned about meningitis ( as it had been in our area), but much later on the same day, after being pumped full of antibiotics,(Ithink) and ibuprofen to get her temperature down, she was a changed child and, it turned out, it was " just a virus".
I think it is very, very hard for medical staff to be sure. Panic-stricken mothers telling them what they think they should be doing must really get their backs up.
I'm sorry you had such a horrible time...It is an awful thing to see a small child so poorly.

I think you should also request all your sons notes to see how it was recorded from the hospitals view point, so you can see their stance on what happened. Good Luck Op xx

You do need to complain. Mistakes are made in every organisation but the health service is one that needs to be very careful and they will only learn if things are pointed out. We did not complain when medical negligence killed my mil but when my fil died on the same ward 18 months later we did complain. Although they offered us money without being asked as a settlement the best thing that came out was a total reorganisation of the ward so it couldn't happen again. When my son died two years ago we had to raise concerns and again certain procedures were changed and they wrote to tell us. I am glad you had a positive outcome.

Yes do complain - if there is something to learn, the next child this happens to may not be so lucky. And anyway as pps have said, just the paranoid mother comment is enough for a complaint. My husband nearly died because of a mistake by the GPs receptionist and I persisted with the complaint until the practice took it seriously, retrained everyone and brought in new protocols. Then I changed practices. No harm came to my dh but I couldn't have lived with myself if I hadn't complained - we all have a collective responsibility in this respect I believe. I have also always found PALs great

jamdonut in this case it would have been very easy for the doctor to assess whether the OP's baby had meningitis...he should have done a blood test. Funnily enough in your description of your dd's situation, it sounds like your dd got the care that the OP's ds didn't get...your dd got antibiotics which OP's ds didn't.
OP you should definitely complain, otherwise that doctor will continue to behave in the same way and maybe next time the ending will not be the happy one that you had.

Complain. Some friends of mine went through similar with their 2 year old 3 years ago. He died of double pneumonia and sepsis. They kept turning them away saying they were paranoid too and that he had chicken pox. He didn't

Communicate effectively
31. You must listen to patients, take account of their views, and respond honestly to their questions.

32. You must give patients the information they want or need to know in a way they can understand. You should make sure that arrangements are made, wherever possible, to meet patients’ language and communication needs.

33. You must be considerate to those close to the patient and be sensitive and responsive in giving them information and support.

34. When you are on duty you must be readily accessible to patients and colleagues seeking information, advice or support.

From Good Medical Practice

I understood that meningitis could be diagnosed by testing the spinal fluid - my DS had that done no delay when they didn't know what was wrong with him - to RULE OUT meningitis.

A blood test was available to pick up infection.

Floppy and unresponsive can be just due to dehydration so you'd attend to that first. Small improvement but not enough, whilst the fluids are going in you invoke the blood test until you've ruled out everything except 'overly concerned on this occasion mother'.

Why should the OP only complain about the stupid and insulting comment the dr made?! The fact her son could have DIED is surely far more important to be dealt with!

How was he in the 3 days? Did you seek further medical opinion? Where you given advise of warning signs to look out for?

As a health care professional I would say definitely write to complain. This is the way we learn, the incident will be investigated and findings passed on to all staff which will hopefully avoid a repeat.

to you and your family

No you are definitely NBU! And yes do complain!

Some Doctors can get complacent and be a little dismissive if the obs and that seem okay / are not life threateningly low.
My DD can go from a bit wheezy to SATs through the floor in a very short time (Asthma). I'm also asthmatic and had to be readmitted via 999 because a Doctor decided I was okay to be discharged, despite being on a neb and the nurse telling him I needed bloods doing before I left. They only found the pneumonia and sepsis in the girl in the bay across from me because her temperature spiked when they were doing 4hrly obs which prompted them to do blood cultures. Her Mum had been arguing the toss with the doctors all afternoon repeatedly telling them her daughter wasn't well and they were dismissing her too.

I'm so sorry you and your DS had to go through that.

lizb30 that's awful bless them

OP I dont know if it will be the same in your DSs case but when I complained to PALs about the Dr dismissing me. They asked me if I wanted them to deal with it via the hospital or through a letter. I got a standard generic phone call off the ward sister saying "they'll have a word with Dr X". I'd do it in writing to force them to respond in detail about why they kept dismissing you.

It's worth speaking to them. My DD was very unwell, she had an operation recently at just 4 months old. After our first hospital visit I was unhappy with the communication between two departments. It didn't make anything worse for DD as her condition wasnt' deteriorating, but I felt it could have done in an emergency situation. I also felt one of the doctors needed extra training in communication (she had a terrible habit of woolly sentences that meant you had to put the pieces together yourself). The complaint (although it wasn't a serious serious complaint) changed a few policies/procedures which should make life easier for anyone else going through the same.

Some doctors are very dismissive of parents. Probably because there are a lot of parents who go to the doctor/a&e at the drop of a hat, but they need to be very careful they don't just assume.

Panic-stricken mothers telling them what they think they should be doing must really get their backs up.

That maybe so but they must remain professional at all times regardless, calling a concerned Mother paranoid is not the way to do it. I remember being that annoying Mother a few years ago. DD had had several chest infections in a short period of time. One time. They sent us round to the GP bit as I was being 'paranoid' too. I pissed them off annoyed them when I insisted on staying in the A & E department and seeing a consultant, and no I didn't care how long I had to wait to see one. My DD was admitted that night.