Ted

Ted developed jaundice as a newborn baby, which is often harmless, but in some babies can lead to complications. For this reason, NHS guidelines exist for how midwives and doctors should treat newborn jaundice. Very sadly for Ted these crucial guidelines were not followed. As a result, Ted became very unwell and was later diagnosed with a type of brain injury called kernicterus.

Steven Brown, a partner in the JMW medical negligence team, took on Ted’s case under a no win no fee agreement and helped his family get answers and challenge the failures in his care. As Ted has lifelong care needs, Steven was also successful in securing compensation totalling £13.5 million that would cover the cost of this, and the financial security he needs.

What went wrong?

Kernicterus is a type of brain injury that can occur in babies with jaundice that has become severe, usually because it has been left untreated. Guidelines from the National Institute of Health and Care Excellence (NICE) state that if a baby develops jaundice after their birth they should have an urgent blood test to measure the level of bilirubin, the substance that causes the yellowing of skin and eyeballs and can cross the blood / brain barrier causing damage to the brain called kernicterus. The guidelines also state the level at which treatment in hospital should be started, which could involve placing the baby under a phototherapy light, or carrying out a blood transfusion if phototherapy is not reducing the level of bilirubin quickly enough. Some babies are at a higher risk of very high bilirubin levels (hyperbilirubinaemia) requiring treatment and this should be recognised by the midwives and doctors who are caring for them after their birth so that they can be alert to any signs of jaundice. High risk babies include those that are born prematurely, and/or are exclusively breast fed.

Two of risk factors for high bilirubin levels applied to Ted as he was born slightly prematurely, a week before his due date, and his mother Kath also planned to breastfeed exclusively. There were no concerns about Ted’s health after his birth and two days later he and Kath were discharged.

The following afternoon, Kath and Ted were visited by a community midwife who recorded in her notes that Ted was slightly jaundiced. Kath and Ted received a further visit from the same community midwife two days later. The midwife again recorded the jaundice in her notes but did not take a blood test to measure how much bilirubin was in Ted’s blood. Three days later the midwife returned and again no action was taken to test and treat the jaundice, despite the risk of significant injury to Ted.

Kath became increasingly concerned about Ted. His jaundice was not improving, and he was feeding poorly. On two consecutive days she contacted the maternity hospital to make them aware of these symptoms and her concerns about Ted. On both occasions she was reassured that he was fine and no review of Ted by midwives or doctors was arranged.

Kath remained very concerned and called the on-call midwife, telling her that Ted was also sleepier than he had been previously. The midwife advised Kath to keep an eye on Ted overnight and call back tomorrow if she was still concerned.

After Kath called NHS 111 the following day, a midwife visit was arranged. The midwife who attended found Ted to be very jaundiced and lethargic. She called an ambulance and Ted was taken to hospital.

At hospital, a bilirubin blood test was finally taken, and Ted’s levels were found to be extremely high. He was taken to the neonatal intensive care unit for a blood transfusion and his bilirubin levels were brought under control. However, an MRI scan later revealed that the bilirubin had crossed the blood brain barrier and had caused him kernicterus brain damage.

JMW’s investigation

Ted’s parents were distraught that he had suffered such an appalling injury due to jaundice and treatment having only been started when it was too late to prevent brain damage. The jaundice had been noticed by the midwife at an early stage and Kath has raised the alarm about his worsening condition, to no avail.

Ted’s family contacted JMW for advice due to our extensive experience in similar cases. Steven Brown, a partner in the medical negligence team, took on Ted’s case and carried out an extensive investigation into the care he received. After gathering independent evidence from medical experts in the relevant fields, Steven had evidence that Ted’s brain damage was preventable with earlier testing and treatment.

Steven was keen to progress Ted’s case was quickly as possible so that he could obtain the support and specialist care he needed. However, the hospital trust initially denied that it was responsible for Ted’s brain injury. Steven pushed on with the case until the trust accepted that Ted should have been tested at an earlier stage and that if he had he would have avoided the kernicterus brain injury.

With that this side of Ted’s case concluded, Steven was able to start investigating what Ted’s needs would be at each stage of his life and how much compensation would be required to provide for them. Steven was then able to negotiate with the hospital trust so that Ted would be awarded the maximum amount of compensation he needed and be able to live as independent a life as possible.

Kernicterus compensation awarded

Ted’s physical and learning disabilities are severe and it was agreed that he would need carers for the rest of his life. He also needed to move to a different house on one level that could be adapted to his physical needs as he is unable to walk and relies on a wheelchair for his mobility. Other items, such as specialist equipment and a vehicle were provided for, as was therapy including physiotherapy. Over the course of Ted’s lifetime, the amount of compensation that was agreed totalled £13.5 million. Nothing could turn back the clock, but the compensation has enabled Ted to have the best possible quality of life and financial security.

Steven Brown, a partner at JMW who specialises in kernicterus cases and acted for Ted, commented: