The failure of a doctor to order a 15-minute scan on a two-year-old girl displaying signs of a brain tumour “contributed to her death”, a coroner has ruled.
Dr Andrew Harris said there had been a “gross failure to provide medical care” by consultant paediatrician Dr Majeed Jawad in his treatment of Keira Lee (pictured above) on October 26, 2013, at the private Spire Gatwick Park hospital in Horsley, Surrey.
She died six weeks later, on December 5, 2013, in King’s College hospital, Denmark Hill, after undergoing an operation to remove the 5cm tumour – surgery that may never have been needed if it had been spotted earlier.
Dr Harris, in a narrative verdict last Thursday [April 30] at Southwark coroner’s court, said: “The failure of the paediatrician to refer for a scan at the end of October contributed to her death.”
Keira’s parents, Tim and Kirsty Lee, who live near Horsley, told the Standard: “The death of our beautiful daughter Keira is obviously totally devastating for us as a family.
“Whilst the inquest was emotionally very difficult, we hope that it has in some way helped to raise awareness of childhood brain tumours and maybe save lives in the future. The coroner’s verdict supports our belief that if Keira had been diagnosed sooner then she would be with us today.”
During his evidence, Dr Jawad apologised to the family for failing to diagnose the tumour. “I feel very, very sorry,” he said.
Under questioning from the coroner and cross-examination from the Lee family’s barrister Bridget Dolan, Dr Jawad admitted he had been ignorant of Royal College of Paediatrics and Child Health guidelines on treating brain tumours, and failed to order neurological checks despite Keira displaying “red flag symptoms” of different-sized pupils and facial palsy.
Mr Harris told him: “That wasn’t very confusing, was it? It couldn’t be clearer, if you had examined her, that she had two abnormal focal signs.”
Dr Jawad replied: “At that time, Keira didn’t have the classical symptoms that are part of a brain tumour.”
Dr Harris expressed concern at the lack of specialist paediatric nurses in the post-operative area at King’s, which is a regional centre for neurosurgery. He is to demand immediate action from hospital bosses as he fears the shortage of nurses means there is a risk of future deaths.A prevention of future deaths report will be issued in due course.
Joanna Hunter, divisional head of nursing for critical care at King’s, admitted to the hearing that the hospital remained in breach of Royal College of Nursing guidelines 16 months after Keira’s death. She said she was trying to recruit two specialist nurses but admitted five were needed to ensure 24/7 cover.
King’s College hospital said there was a national shortage of paediatric nurse specialists. “Until these posts are filled permanently, we have a paediatric nurse seconded into the department to help treat children after their operations,” a spokeswoman said after the inquest. “Recovery also has access to a 24-hour rota system, which means there is always a paediatric nurse on-call should they be needed.”
In a statement afterwards to the Standard, Dr Jawad said: “This is a very sad and tragic case and I would again like to extend my deepest sympathy to Keira’s family. I accept the findings made by the coroner and sincerely hope that the inquest process has provided Keira’s parents with the answers to their questions.”
On the first day of the inquest, Mrs Lee told how she feared Keira would “internally combust” after reacting badly to an operation to treat a brain tumour.
She became anxious that doctors at King’s College hospital were unable to ease her daughter’s post-operative distress after emergency surgery on December 3, 2013.
The child “with a beaming smile and heart-melting giggle” died two days later after a “catastrophic stroke” caused by a brain stem hernia.
Ms Lee told Southwark coroner’s court: “I felt it was out of control. My feeling at the time was that she had just had brain surgery. The way she was behaving with her heart rate, her body just seemed in far too much distress.
“In my opinion, the only words I can find is that it felt if it continued the way it did and she wasn’t put to sleep or helped to relax in some fashion, she would internally combust.”
Keira, the fourth child of Mr and Mrs Lee, had been transferred to the specialist neurology department at King’s after being rushed to her local A&E on November 27, 2013.
A CT scan ordered by doctors at East Surrey hospital, in Redhill, had uncovered a 5cm tumour in the centre of Keira’s brain – explaining what lay behind her deteriorating condition that had gone undiagnosed by doctors at the Spire hospital.
Her parents had become increasingly concerned during the preceding two to three months as Keira lost her appetite, vomited more frequently and became lethargic.
She was seen on three occasions in October and November 2013 by Dr John Brookes, an ear, nose and throat consultant at Spire Healthcare.
He admitted in court that he failed to order neurological tests that mighty have detected the tumour, saying he believed she had a nasal problem but was reassured when she smiled.
The coroner said Mr Brookes had failed to react adequately to the Keira’s history of gagging and vomiting and the concerns of a “reliable and experienced mother”.
Mr Brookes was shown photographs of Keira taken in October and November 2013 and admitted they showed different pupil sizes and a weakness on the side of her face.
Mr Brookes told the hearing: “I would like to say to Mr and Ms Lee how sorry I am that I missed the diagnosis.”
* The Lee family is raising awareness of brain tumours at: loveukeira.co.uk
Edited versions of this story have been published in the Evening Standard: