Girl, 13, not checked for sepsis before 'unbearably' painful death

A 13-year-old girl was dismissed as 'dramatic' and not checked by doctors for sepsis before her death despite showing the warning signs of the deadly infection, an inquest heard today.

Chloe Longster, of Market Harborough, Leicestershire, died in 'unbearable pain' less than 19 hours after her admission to Kettering General Hospital in Northamptonshire in November 2022.

She had been suffering severe pain in her lower rib and cold-like symptoms with doctors diagnosing pneumonia before she rapidly deteriorated.

The second day of the hearing was told how the youngster hit a vital sepsis trigger point in the hours before she suffered a cardiac arrest.

But medical staff did not initially screen her for the condition after a nurse believed her symptoms could be related to pain or another illness.

The inquest at Northampton's Guildhall heard from experienced nurse Tanya Ball, who started her bank shift at 7pm on the night Chloe was admitted to Skylark Ward at Kettering General Hospital.

Ms Ball said that Chloe's mum Louise Longster had gone to the nurses' desk twice during their half-hour handover to say her daughter was in pain.

The nurse then went to see Chloe. She told the hearing: 'She was complaining of a lot of pain.

'She didn't look quite right, so I put a monitor on her and went to find a doctor to see if we could give her anything for the pain.'

The doctor told Ms Ball he would return later to fit a cannula so Chloe could be given intravenous drugs.

All hospitals use the national Paediatric Early Warning System (PEWS) to ensure they track any deterioration in young patients.

Ms Ball told the court that Chloe's PEWS score went up from five at admission to Skylark, to eight when she checked again around midnight.

Despite this, the nurse did not start the sepsis screening.

Coroner Sophie Lomas asked her if that score should have triggered a sepsis screening.

She said: 'Yes it should have. I didn't consider doing the sepsis screening.. I thought it was pain related.

'I just didn't think about it to be honest.'

The nurse had asked doctors to repeat Chloe's blood gas test and x-ray as she believed that the pain may be related to another condition like pneumothorax.

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Chloe's blood results showed she had influenza A, so she was moved to a side room for infection control.

Ms Ball told the inquest: 'As we were moving her on the bed she was complaining about a lot of pain and was unable to take a proper breath due to the pain.

'She was in quite a lot of distress so I asked mum was this out of character for her. She said yes.

'We got her into the cubicle and I went back to the doctor and said she's in a lot of pain. At this point she still didn't have a cannula.'

On moving Chloe, Ms Ball said she noted the raised PEWS score and a registrar named Doctor Saw came in to fit a cannula.

While she was in the room, Chloe's monitor began to beep and her oxygen saturation level dropped to 88 per cent, but Dr Saw did not appear to Ms Ball to have taken any action.

Ms Ball was also asked about Mrs Longster's two visits to the nurses' station to ask for pain relief for her daughter earlier in the evening.

The coroner said: 'From their perspective they felt they were being fobbed off. Do you recognise that?'

Ms Ball replied: 'I feel that I took it seriously. I'm sorry that it didn't come across like that.'

The court also heard evidence from Dr Saw, the registrar who was part of the team that cared for Chloe in the hours before her death.

She said that the paediatric consultant, Dr Mya Mya Yee had asked her to go and fit Chloe's cannula so she could be given intravenous medicine.

Dr Saw said: 'She was talking with me and engaging with me.

'When I looked at her I didn't feel that she was very, very unwell.

'She didn't look like someone who was going to deteriorate within a few hours.'

Later in the evening she was present when Chloe suffered a cardiac arrest.

Dr Saw said: 'She'd had intubation and difficulty with secretions then she had a cardiac arrest.

'CPR was administered and she had a return of spontaneous circulation and was stabilised.'

Chloe was taken to the ITU, but her condition did not improve and she again collapsed before dying at 6.48am when doctors took the decision to withdraw life support.

Earlier on Tuesday, the inquest heard how her mother Louise repeatedly asked medics for help, but was treated as a 'mum who had been on Google' while her daughter was dismissed as a 'diva teen'.

She said her daughter had been in so much pain she asked her whether she was going to die - adding: 'It's haunting that the 13-year-old was the one who was right.'

The mother claimed she was not informed of a sepsis screening and said pain relief for her daughter was 'delayed' with the youngster being treated with 'contempt' in the final hours of her life. 

The 40-year-old added that her daughter was never given an identification bracelet. 

During the first day of the a week-long inquest, the mother said she had been left 'devastated' by Chloe's death, which her family believe was 'completely preventable.'

The teenager, an IVF baby and keen dancer of Market Harborough, Leicestershire, had been sniffly and had a cough the weekend prior, but had been well enough to attend a sleepover.

Assistant coroner Sophie Lomas also heard that Chloe had mild asthma and used inhalers, but had never had an asthma attack.

The inquest was told that Chloe was unwell on November 28, so was left at home with her brother 17, with instructions to call if her condition changes. 

At around 11.15am Chloe had contacted her mother to say her ribs were in pain and that she had been sick.

After her Chloe's father had returned to the home to check on the teenager, Mrs Longster returned home to assess her daughter's condition. 

She added: 'I could see she was becoming more and more uncomfortable and panicked about the pain.'

When asked by the coroner if this was unusual for Chloe, the mother said 'Yes,' adding: 'She liked to go out to dancing, she liked to live and being ill was massively inconvenient for her. It was very out of character.'

After being told an ambulance would take two hours and unable to contact a GP, the mother took Chloe to Kettering General Hospital by car.

'She was frightened. She was holding my hand, she was squeezing it,' Mrs Longster said.

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The inquest heard that Chloe was in so much pain she was unable to walk and had to be taken into the hospital via wheelchair by her brother. 

She was then triaged and placed in a side room before being given oral Oramorph for her pain.

Mrs Longster added: 'She asked if she could be put to sleep because she was in so much pain. 

'She said to me 'stop saying it's going to be OK mum. It hurts.''

The teenager had a cannula inserted but it fell out whilst she was still in A&E, with her mother and brother later having to take her down to X-ray themselves.

Mrs Longster said she saw the X-ray and noticed what she thought was a mass at the bottom of Chloe's lung.

When she returned to the A&E department the mother was told Chloe had a chest infection.

A doctor prescribed antibiotics and she was given one dose before being admitted to the Skylark Ward.

When on the children's ward, Mrs Longster said she had to repeatedly ask doctors for more pain relief for her daughter.

'I remember making a comment that it feels like we are chasing her pain, not getting on top of it,' she said.

An on-call doctor then saw Chloe and told her mum she had pneumonia and would need to be admitted for intravenous antibiotics and fluids.

She also told of how she went straight to the nurses' station when they arrived on the ward, and felt she was having to persuade staff her daughter was unwell. 

'I remember in A&E having to convince them she really wasn't well. I was not a mum who'd been on google and she wasn't a dramatic teenager,' Mrs Longster said.

'Somebody [on Skylark] asked: ''What's your name?', I said I was Chloe Longster's mum and they said 'we know about her and we'll be round'.

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'I remember that sinking feeling because their interpretation of me had obviously transferred upstairs.

'I went back and messaged my husband and said I didn't think they were taking it seriously.

'I was told by another mum that there was a poorly baby on the ward and, I get that, but my baby was poorly too.'

By 9pm Chloe had settled a little but was still wincing with the pain. No cannula had yet been fitted.

She said: 'A nurse kept coming in to do observations but nothing was happening.

'I asked what was going on and she said 'she's on red'. I thought to myself 'don't google it because I'll panic'. But I shouldn't have to google it.'

When the nurse returned to do  more observations on Chloe later, she  realised her oxygen level had dropped, with Mrs Longster noting: 'They initially thought the machine had broken.'

Chloe was moved to a side room and Mrs Longster was told this was because she had tested positive for Influenza A, the inquest heard.

A consultant was called and more people began coming into Chloe's room.

Mrs Longster said: 'I asked a nurse if she was going to be OK and the nurse said she didn't know.

'How I got out of the room I don't know, but I just remember hitting the floor and being slumped there.

'It felt like Chloe hadn't been taken seriously about how unwell she was until that point.

'She had asked me if she was going to die. I took that as her trying to articulate how poorly she felt. It's haunting that the 13-year-old was the one who was right.

'During Chloe's last 18 hours on this earth she was in pain and treated with contempt.'

Mrs Longster said that she got the impression nurses believed Chloe was being 'dramatic'.

She outlined an incident where a nurse abruptly told her that by breathing in the way she was, she was making her pain worse.

'I still think there were preconceived ideas,' she said: 'Chloe asked for her duvet to be brought in but I thought that was just going to exaggerate the diva teen thing.'

During her time on A&E, Chloe was seen by Dr Marwan Gamaleldin who was, at that time, a registrar.

He said a nurse had come to find him at about 2.20pm to ask him to see Chloe because she had started the sepsis screening tool but Chloe's score had not been high enough to trigger further examination.

The court heard that during any admission at least one blood pressure should be recorded as part of observations to give doctors a baseline for each patient.

The doctor took her blood pressure on both arms during his own separate examination to see if there was a difference but he had no concerns.

Dr Gamaleldin did not record the blood pressure in his notes.

He was asked how many times he had seen Chloe in the two hours she was there. He said it was three or four and said that his notes were made retrospectively.

He told the inquest: 'She didn't come across as struggling to breathe. Breathing with pain is different to struggling to breathe.'

He said he began thinking about a 'differential' diagnosis than a bacterial infection because of her pain level and high heart rate.

He said: 'I saw a shadow on the left side of her lung in the X-ray. In that context, infection was likely.

'I remember saying that the pain wasn't proportional to what we'd normally see in an infection.

'The absence of fever is a red flag. If there's no fever and a high heart rate you start to think about something else.'

The inquest continues until Friday at The Guildhall in Northampton.