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Doctor criticised after baby dies while in care of privatised GP service Doctor criticised after baby dies while in care of privatised GP service
(7 months later)
The performance of a doctor treating a seven-week-old baby boy who died while in the care of the privatised out-of-hours GP service in north London was "wholly inadequate", a coroner said on Thursday.The performance of a doctor treating a seven-week-old baby boy who died while in the care of the privatised out-of-hours GP service in north London was "wholly inadequate", a coroner said on Thursday.
Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence", according to Dr Shirley Radcliffe, the St Pancras coroner.Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence", according to Dr Shirley Radcliffe, the St Pancras coroner.
Axel, previously fit and well, died last November, having contracted a routine cold which developed into a lung infection that went untreated, despite repeated calls and visits by his parents, Linda Peanberg King and Alistair King, over the course of five days to the service and their own GP. Out-of-hours GP cover is run under contract to the NHS in the north central London region by private provider Harmoni.Axel, previously fit and well, died last November, having contracted a routine cold which developed into a lung infection that went untreated, despite repeated calls and visits by his parents, Linda Peanberg King and Alistair King, over the course of five days to the service and their own GP. Out-of-hours GP cover is run under contract to the NHS in the north central London region by private provider Harmoni.
On the day the baby died, Shantikumar failed to ask the family the essential questions to determine how serious the case was. He downgraded Axel's priority, which had been classified as urgent by a Harmoni call handler, to routine, following his very brief telephone assessment so that the baby was only given an appointment to see a doctor face-to-face three and a half hours later.On the day the baby died, Shantikumar failed to ask the family the essential questions to determine how serious the case was. He downgraded Axel's priority, which had been classified as urgent by a Harmoni call handler, to routine, following his very brief telephone assessment so that the baby was only given an appointment to see a doctor face-to-face three and a half hours later.
When Peanberg King attended the Harmoni clinic, which is located alongside the NHS A&E department in north London's Whittington hospital, she was made to wait with her baby in a queue with six patients ahead of her.When Peanberg King attended the Harmoni clinic, which is located alongside the NHS A&E department in north London's Whittington hospital, she was made to wait with her baby in a queue with six patients ahead of her.
An off-duty NHS paediatric nurse who happened to be sitting near them in the queue realised the gravity of his case and immediately rushed them into the NHS A&E department next door, where frantic efforts were made to resuscitate him in vain. He was declared dead when his father, who had been at home looking after the couple's older child, arrived at the hospital.An off-duty NHS paediatric nurse who happened to be sitting near them in the queue realised the gravity of his case and immediately rushed them into the NHS A&E department next door, where frantic efforts were made to resuscitate him in vain. He was declared dead when his father, who had been at home looking after the couple's older child, arrived at the hospital.
The Guardian revealed last December that staff at the Harmoni service feared delays in treating the baby may have contributed to the tragedy. It is very rare, although not unprecedented, for babies in the UK to die of pneumonia.The Guardian revealed last December that staff at the Harmoni service feared delays in treating the baby may have contributed to the tragedy. It is very rare, although not unprecedented, for babies in the UK to die of pneumonia.
Recording a narrative verdict which did not apportion blame to individuals, the coroner said it was not possible to say whether intervention at an earlier stage that day would have changed the outcome. Babies that age can deteriorate very rapidly and sadly a few do die, the court heard.Recording a narrative verdict which did not apportion blame to individuals, the coroner said it was not possible to say whether intervention at an earlier stage that day would have changed the outcome. Babies that age can deteriorate very rapidly and sadly a few do die, the court heard.
The coroner also found that the consultations and assessments made by staff for the out-of-hours service over the previous few days were appropriate. Two days before he died, the baby had been seen by Dr Kuljeet Takhar, supplied to Harmoni by an agency. The parents had previously reported that Axel was having difficulty breathing, but when Takhar carried out a full examination, he found the baby's lungs were clear and the coroner accepted that at that point the diagnosis of an upper respiratory tract infection was appropriate. Takhar gave a deferred prescription for antibiotics. It was not best practice to do so in babies so young, the coroner said, but Radcliffe also noted that Takhar had told Peanberg King not to be too reassured because very young babies can change very rapidly.The coroner also found that the consultations and assessments made by staff for the out-of-hours service over the previous few days were appropriate. Two days before he died, the baby had been seen by Dr Kuljeet Takhar, supplied to Harmoni by an agency. The parents had previously reported that Axel was having difficulty breathing, but when Takhar carried out a full examination, he found the baby's lungs were clear and the coroner accepted that at that point the diagnosis of an upper respiratory tract infection was appropriate. Takhar gave a deferred prescription for antibiotics. It was not best practice to do so in babies so young, the coroner said, but Radcliffe also noted that Takhar had told Peanberg King not to be too reassured because very young babies can change very rapidly.
The family said they were not satisfied that they had got to the truth. "We believe there are still many questions to answer about the safety of the service provided by Harmoni. We do not believe that anyone hearing all the evidence in this case could have full confidence in its services. We are now considering all our options to prevent any other children from falling through the net."The family said they were not satisfied that they had got to the truth. "We believe there are still many questions to answer about the safety of the service provided by Harmoni. We do not believe that anyone hearing all the evidence in this case could have full confidence in its services. We are now considering all our options to prevent any other children from falling through the net."
Ellen Parry, from the clinical negligence team at law firm Leigh Day, who is representing Axel's parents, said:Ellen Parry, from the clinical negligence team at law firm Leigh Day, who is representing Axel's parents, said:
"Both Linda and Alistair want to know how their otherwise healthy baby, after repeated visits and calls to this privately run clinic, died from a treatable illness, a death that we believe was entirely preventable."Dr David Lee, medical director for Harmoni, said: "We would like to express our deepest and heartfelt sympathy to the Peanberg King family."Both Linda and Alistair want to know how their otherwise healthy baby, after repeated visits and calls to this privately run clinic, died from a treatable illness, a death that we believe was entirely preventable."Dr David Lee, medical director for Harmoni, said: "We would like to express our deepest and heartfelt sympathy to the Peanberg King family.
"We believe we have the right underlying systems, policies and procedures to ensure a safe and robust-out-of hours service. We will now be taking full regard of the coroner's findings."We believe we have the right underlying systems, policies and procedures to ensure a safe and robust-out-of hours service. We will now be taking full regard of the coroner's findings.
"We know that the review of very difficult incidents such as this always identifies learning points. Our overriding priority is to ensure that this learning is acted on.""We know that the review of very difficult incidents such as this always identifies learning points. Our overriding priority is to ensure that this learning is acted on."
The court heard that over the period that the family were in contact with the service there were three gaps in the rota for staff to assess and see patients but Lee said that staffing levels had been safe at all times since slack was built in to allow for people being off ill or for shifts to be unfilled.The court heard that over the period that the family were in contact with the service there were three gaps in the rota for staff to assess and see patients but Lee said that staffing levels had been safe at all times since slack was built in to allow for people being off ill or for shifts to be unfilled.
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