NHS hospitals have a potentially fundamental problem with diagnosing sepsis in children, a coroner has told the health secretary after a nine-year-old died in similar circumstances to Martha Mills.
Mary Hassell, the senior coroner for inner north London, has written to Steve Barclay at the conclusion of an inquest into the death of Riya Hirani.
The previously “strong, healthy and active” girl was taken to hospital after her mother noticed she was “very sick” but a junior doctor sent her home with painkillers after a diagnosis of tonsillitis.
Riya’s condition deteriorated the next day, however, and as her parents were preparing to take her back to hospital, she collapsed and her heart stopped. Paramedics revived her, but she died five days later at Great Ormond Street Hospital in London.
In a letter to Barclay, Hassell compared the case to the circumstances surrounding the death in 2021 of 13-year-old Martha. “On each occasion a parent’s articulately expressed and ultimately prescient concerns about a previously healthy but rapidly deteriorating child did not result in appropriate escalation of care,” she wrote.
In her prevention of future deaths report, the coroner urged the health secretary to take note of Riya’s death when making a decision regarding appeals for the government to legislate for a “Martha’s rule”.
The proposed rule, for which Martha’s parents are campaigning, would give families and patients the explicit right to a second opinion if they felt their concerns were not being taken seriously.
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Hassell told the health secretary that “although the events bringing the two children to hospital were very different, as I listened to the evidence at Riya’s inquest I noticed some striking similarities between the circumstances of Riya’s treatment and those of Martha Mills”.
She added that there seemed to be a “fundamental issue regarding the lack of appropriate diagnosis and treatment that is apparent locally but relevant nationally”.
The latest inquest heard that Riya was taken to Northwick Park Hospital in Harrow, northwest London, just before Christmas last year. Her mother, Geeta Hirani, was convinced that her child was “extremely ill”, the hearing was told.
However, instead of giving her intravenous antibiotics and admitting her to hospital, a junior doctor “diagnosed a virus and discharged her with advice to take over-the-counter painkillers and a sheet describing the management of sore throats”, Hassell said.
The inquest was told that Hirani questioned the doctor about whether Riya’s illness could have been caused by a streptococcal infection, but her suggestion was dismissed.
Addressing failures in the initial diagnosis of the child’s condition, the coroner said that “no thought was given to seeking a second opinion” and that it was “highly likely that if it had been open to Riya’s family to seek a second opinion at that point, they would have done so without hesitation”.
Hassell set a deadline of November 13 for the health secretary to respond to her report.
