‘Missed opportunities’ before baby Esta died of meningitis at Leeds hospital, inquest told
“The earlier antibiotics were started the more likely that the outcome would have been different”
A five-month-old girl who died from meningitis in hospital probably would have lived if antibiotics were administered earlier and doctors had looked beyond their diagnosis of Covid, an expert has told an inquest jury.
Professor Simon Nadel agreed there were “missed opportunities” at Leeds General Infirmary that “more than minimally, negligibly or trivially” contributed to the death of Esta High, when he appeared at Wakefield Coroner’s Court on Thursday (October 15).
Prof Nadel, who is a consultant in paediatric intensive care, was giving expert evidence at the inquest into the death of Esta, whose parents say died because clinicians missed vital chances to spot her bacterial infection and start antibiotics because they were convinced her symptoms were down to the Covid virus.
The professor was taken through Esta’s time at the hospital by assistant coroner Naomi McLoughlin, from when she was taken into the emergency department by her parents Lynsey Carr and Leon High with a high temperature and vomiting on October 31, 2023.
The inquest jury has heard how Esta tested positive for Covid and was kept in the hospital because of concerns from her parents despite staff wanting to send her home.
They were then told how Esta was eventually given antibiotics on the evening of November 2 and admitted to intensive care but it was too late to save her.
Prof Nadel was asked by Rachel Young, representing Esta’s parents, whether blood cultures should have been taken when she arrived at the hospital as she presented as a risk of sepsis.
He agreed with Ms Young that “there was a missed opportunity on October 31 to comply with national guidelines for obtaining blood tests and blood cultures that materially contributed to the outcome in this case”.
The professor also agreed that there were further missed opportunities “to have saved Esta’s life” from the night of November 1 through to the morning of November 2.
On each occasion he said the observations on Esta should have resulted in a medical review by a senior doctor which, he believes, should have meant a re-diagnosis and the earlier starting of antibiotics.
Prof Nadel was asked about a doctor’s decision at about 8am on November 2 to continue to attribute Esta’s symptoms to Covid and not go down a different diagnostic route which would have resulted in antibiotic treatment.
He agreed that this too “more than minimally, negligibly or trivially contributed to Esta’s death”.
The professor said that by midday on November 2, when Esta began showing clear signs of seizures, this was the point at which antibiotic intervention would probably have been too late.
Under questioning by Megan Crowther, for Leeds Teaching Hospitals NHS Trust, Prof Nadel admitted he had changed his opinion about when starting antibiotic treatment is likely to have led to a different outcome, compared with his statements.
But the professor said that this showed just how difficult it was to put a timescale on these judgments and stressed the opinions he gave to the jury were “on the balance of probabilities” and not certainties.
He also stressed that the presence of Covid made decision-making more complicated for the doctors involved.
The professor said: “I have said all along that the earlier antibiotics were started the more likely that the outcome would have been different.”
He said his opinion was that the cause of Esta’s death was pneumococcal meningitis, but agreed with the coroner that this was for the jury to formally determine.
Last week, Ms Carr told the jury how her daughter was a “happy, healthy, smiling girl” before she became ill on October 31.
She explained how Esta’s condition deteriorated in hospital but her and Mr High’s concerns were repeatedly ignored by staff until it was too late.
She said the family, from Leeds, were put in a side room at the hospital’s children’s assessment and treatment (CAT) unit where she believed staff were more concerned with isolating Esta because of the Covid risk than listening to her parents.
Ms Carr said the family’s concerns over her symptoms, some of which they captured on a video shown to the jury, were “dismissed on multiple occasions”.
She told the jury: “Unfortunately, as our daughter had been left untreated for 55 hours, it was too late to save our darling girl.”
Ms Carr said her daughter was “bright, beautiful and perfect from the first moment” and “when she arrived, she completed us”.