Medics could not have stopped Cornwall six-year-old's sepsis death, says doctor

Doctors treating a six-year-old girl from Cornwall could not have saved her before she died of sepsis while battling a rare kidney condition, an independent expert has said.

Coco Rose Bradford was admitted to the Royal Cornwall Hospital, known as Treliske Hospital, in July 2017.

She was discharged but then readmitted overnight and transferred to the Bristol Royal Hospital for Children, where she later died. Blood tests showed Coco had “overwhelming sepsis”. 

Before being admitted to hospital, the six-year-old suffered from severe vomiting and diarrhoea. Her family said medical staff were “dismissive, rude and arrogant”. 

An inquest sitting in Truro is considering whether a different course of treatment may have saved her life.

Coco’s mother Rachel Bradford said doctors failed her daughter, while an independent report in 2018 found opportunities were missed. They included failing to recognise Coco was in septic shock and failing to administer an inadequate fluid management plan, which could have changed her course of treatment.

The trust has previously offered an unreserved apology for failings in the six-year-old's care.

It further found there had been a delay to starting antibiotics overnight on July 27 when Coco’s test results showed she had developed sepsis.

The inquest heard Coco, who was autistic and had limited speech, had become very distressed at having a cuff placed on her and nurses had been unable to take a reading.

It has emerged the hospital’s specialist learning disability and autism service were never called in to help.

Dr Yincent Tse, a consultant paediatric nephrologist at Great North Children’s Hospital in Newcastle Upon Tyne, said he did not believe Coco could have been saved while speaking at the inquest on Thursday (December 9).

The inquest previously heard Coco had developed haemolytic uraemic syndrome (HUS) – a rare condition triggered by E.coli that causes the destruction of red blood cells.

“I think, sadly, this was going to happen.”

Giving evidence to the inquest, Dr Tse explained there is no proven treatment for the condition, but there is evidence it is “self-limiting”, meaning it can run its course on its own.

Antibiotics are not recommended, the inquest heard, because they can cause the E.coli bacteria to release its toxins, worsening the disease.

Left to itself, there is the possibility the E.coli might pass out naturally.

The inquest also heard doctors decided to give Coco half the level of fluids recommended by the National Institute of Care Excellence (NICE) because of concerns about kidney damage.

Dr Tse said: “I think it is a reasonable course of action because while you can give half (fluids) you can’t take away half, and if there is kidney shutdown there is a worry that the lungs will start filling up with fluid if you give too much.”

Dr Tse was asked if it would have changed the outcome if Coco had been admitted on July 25 and given “optimal fluids” instead of being sent home.

He replied: “Unfortunately, because there is no treatment for the HUS toxin or the disease itself, I don’t think that would have made a difference.”

There was also a delay moving Coco from a general paediatric ward to the intensive care unit, which Dr Tse believed would not have saved her life had it been done differently, saying: “I think, sadly, this was going to happen.”

“Although her perfusion (blood flow to organs) wasn’t very good, she eventually, after a few hours of delay, got the treatment that she needed,” he said.

“But despite that, over the next few days in (intensive care) with maximum support, she continued to deteriorate.”

Dr Tse was asked whether he believed medics should have given antibiotics at the point it was clear Coco had sepsis.

He replied: “I would share the hesitation in giving antibiotics, however I think that if at the time (colleagues) think giving antibiotics might be helpful because of developing sepsis, I think that any nephrologist would go along with that.”

Another failing identified by the independent review into Coco’s death was that her blood pressure was not taken until 36 hours after she was admitted to hospital.

The inquest will hear the final evidence today (December 10), with Coroner Andrew Cox due to deliver his conclusions on a date yet to be set.