Parents won’t ‘ever forgive’ hospital after baby died following ‘serious failings’

Six-month-old Harris James died at the James Paget Hospital after a heart defect was undiagnosed. PHOTO: Parliamentary and Health Service Ombudsman (Image: Archant)

Harris James passed away at the James Paget Hospital (JPUH) following a heart attack after staff failed to identify a heart defect in November 2015, instead suspecting sepsis and pneumonia.

Now, more than four years later, the Parliamentary and Health Service Ombudsman has found the baby's death was avoidable and that the youngster could have been saved, criticising serious failings at the Trust.

Harris was initially referred to the JPUH NHS Foundation Trust on November 2 2015 after a bout of gastroenteritis sparked concerns over his weight loss, with his GP noting an area of his stomach was drawn inwards, just below his ribs, although this was not recorded in medical notes at the Trust.

Staff carried out blood and urine tests and an appointment was made with a dietitian four weeks later.

However, Harris was rushed to the hospital's A&E department just over a week later, on November 12, after vomiting and becoming limp.

He was given a chest X-ray, which showed part of his lung had filled with fluid, while an electrocardiogram (ECG) showed several abnormalities in his heart.

At the time, the Trust suspected Harris was suffering from pneumonia so gave him oxygen, antibiotics and fluids, but staff failed to consult a specialist about the heart abnormalities.

Despite his age and signs of his condition worsening, he was not seen by a consultant until the following morning. He suffered a heart attack and died shortly after.

The Ombudsman found the Trust failed to act on results of an X-ray and ECG, which showed fluid in his lung and heart abnormalities, as well as failing to consider his history and symptoms, ask for input from specialist staff, or escalate his care when his condition worsened.

A report from the Ombudsman stated: "If these failings had not occurred, it is likely the Trust would have recognised he had a problem with his heart.

"In these circumstances, he would have received the correct treatment instead of being treated for suspected pneumonia.

"We found that, on the balance of probabilities, his cardiac arrest would not have occurred and it is more likely than not his death would have been avoided."

Harris' mother Mary Gunns, a local government officer from Lowestoft, complained to the Ombudsman after being unhappy with the Trust's care and treatment towards her son, as well as the handling of their investigation into his death.

After the Ombudsman found the Trust was not "open and accountable" in the handling of the complaint, the Trust formally apologised and followed the recommendation to pay £15,000 in recognition of the failures and "injustice" caused.

In a joint statement from Harris' parents, Mary and Ryan, they said: "Our son was an affectionate and sweet little boy whose sudden death devastated our family.

"We won't ever be able to forgive the James Paget Hospital for its failings, nor will we forget the additional pain caused by its mishandling of our complaint.

"We hope that, following the Ombudsman's recommendations, the Trust takes action to make sure this never happens again."

The Trust has also agreed to the Ombudsman's recommendations to develop an action plan to address its failings and outline how it will prevent them happening in the future.

Anna Hills, chief executive at the JPUH NHS Foundation Trust, said: "We have apologised to Harris' family for the failings in his clinical care, and for the manner in which we communicated with them and handled their complaint when they raised concerns after his death.

"As an organisation, we have reviewed how we handled this case, with the support and guidance of the Parliamentary and Health Service Ombudsman.

"We have now implemented changes to ensure that, in the future, action is taken to ensure appropriate clinical escalation in similar situation and also that bereaved parents and relatives are treated with the compassion, sensitivity and respect they deserve.

"I would like to express my sincere condolences to the family once again on behalf of the Trust."

The Ombudsman have publised their recommendation today (December 18), following the closure of their investigation in August.

Ombudsman Rob Behrens said: "This tragic case shows how important it is that people speak up when mistakes are made. It is crucial the Trust learns from its failures to make sure they are not repeated."