Taking Ms P’s baby away without permission and refusing to bring him back
15. We can see from the records that while she was waiting in ED, Ms P fell asleep. At 1.15pm a nurse noted she was sleeping with her baby on a trolley. They noted the baby was awake and almost falling from the trolley. The nurse woke Ms P and warned her of the risk of the baby falling. Ms P explained to the nurse she was very tired. She also explained she could not get out of the house because of having no wheelchair, which she needed because of having cerebral palsy (a condition that affects movement and co-ordination). The nurse escalated the risk of the baby falling to the nurse in charge. The nurse in charge told the attending nurse to wake Ms P up and ask her if the nurses could watch over the baby while Ms P slept. Ms P agreed to this, and the nurse took the baby to the paediatric department within the ED.
16. Our nurse adviser said nurses have a responsibility towards patient’s relatives regardless of age and the nurses were acting for the interests of the family. By taking the baby, with Ms P’s permission, the nurses were letting her rest and protecting the baby from potential harm.
17. The nurse also correctly found an issue with Ms P’s capacity to meet the baby’s needs in the short term. This is in line with the Trust’s safeguarding policy which says, ‘Children’s rights to be safeguarded are paramount. Assessments should measure the potential or actual impact of parental health on parenting, the parent/child relationship, and the child, as well as the impact of parenting and the adult’s health. Appropriate support and ways of accessing it should also be considered in the assessment.
Practitioners working with adults must identify and record on admission if: • They have children or caring responsibilities for children • The adult’s relationship with any children • If there are children, confirm that safe and appropriate childcare arrangements are in place.
• Consideration should also be given to whether the adults presenting condition will impact on their ability to care for the children.’
18. Records show the nurses had concerns about the baby and note the baby’s untidy appearance, developmental status and the fact he was not upset by Ms P’s absence. It became clear the baby had not had their routine immunisations like tetanus, polio and measles. It acknowledged this is parental choice but the nurse felt this was worrying. The nurses had concerns about Ms P’s welfare and the needs of her family.
19. NICE guidance says, ‘Consider child maltreatment if a child's behaviour or emotional state is not consistent with their age and developmental stage or cannot be fully explained by medical causes’.
20. The nurses made a referral to the Trust’s safeguarding lead which was appropriate as they had concerns about the baby’s condition and developmental status. The nurses actions were in line with the relevant guidelines. We have seen no sign that the nurses did anything wrong.
The baby was wrongly admitted as a patient
21. To follow up on their concerns, nurses made appropriate referrals and admitted the baby while waiting for contact from the relevant teams. These actions automatically generated a medical admission for the baby. The baby would not be discharged without the approval of social services, which is what happened here.
22. The Trust’s policy for admissions and discharge for children and young p when there are safeguarding concerns states: ‘6.3.3 Before discharge an agreed and clear multi-agency discharge plan should be documented within the medical record.’
23. We can see the nurses made appropriate referrals and arranged contact with the relevant teams. This generated an automatic medical admission. This was in line with the Trust’s safeguarding policy. We have seen no sign that the nurses did anything wrong.
Staff refused to remove Ms Ps intravenous paracetamol and refused to let her leave hospital with her baby
24. The Trust said because Ms P had capacity, staff would have happily completed her request to remove her intravenous paracetamol if she had asked for this. It apologised if this this was not clear at the time.
25. The Trust’s safeguarding children and young people policy states:
‘6.15 Discharging a child and/or a parent/carer from your service when there are Safeguarding Child and/or adult concerns,
Before any decision is made around discharging a child and/or a parent/carer from hospital where there are safeguarding concerns staff must hold a discharge planning meeting, including all relevant agencies. At this meeting a clear safe plan for discharge must be agreed. If a safe discharge plan cannot be agreed upon then staff should discuss this with the safeguarding team who will support in decision making around next steps and any necessary escalation required. Discharge should not occur until a clear safe discharge plan is agreed.’
26. We can see from the records the ED department contacted social services for approval for the baby to be discharged with Ms P. This is in line with the Trust’s policy. Social services approved the discharge and arranged a follow-up for Ms P. Staff acted appropriately and in line with the Trust’s policy. We have seen no sign that the nurses did anything wrong.
A nurse gave the baby yoghurt
27. In its complaint response the Trust acknowledged its shortcomings in not checking with Ms P about any allergies her baby may have had. It explained the baby seemed hungry and with best intentions was given the yoghurt. It apologised Ms P was not asked if the baby had any allergies or nutritional needs.
28. The Trust accepted that had the baby had a dairy allergy, this could have caused it harm. It explained the incident has been discussed with the nurse and they were reminded of the importance of checking with parents first in future.
29. This is in line with our ‘Principles for Remedy’ that say to put things right, ‘where maladministration or poor service has led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise…
An appropriate range of remedies will include: • an apology, explanation, and acknowledgement of responsibility • remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures to prevent the same thing happening again; training or supervising staff; or any combination of these.’
30. We understand how this upset Ms P. The Trust has acknowledged and apologised for what happened and has taken steps to make sure this does not happen again.
31. We have considered the impact this would have had on Ms P. Ms P has confirmed her baby did not have any allergies so there was no real impact.
32. We think the Trust has done enough to put this mistake right.
Staff said the baby had flat head syndrome
33. We can see from the records the nurses recorded the baby to have a flattened head (positional plagiocephaly). This often happens when babies are left in a lying position for too long. The skull structure is soft and will form a flattened appearance if the baby lies flat for long periods. The nurses also noted the baby had poor muscle tone in their neck and this suggested the baby had not had the opportunity to develop muscle tone.
34. Our nurse adviser said parents are encouraged to help their babies develop head control and muscle tone by supporting them to sit and using ‘tummy time techniques’ (supervising a baby lying on their front for a few minutes several times a day).
35. A baby develops quite rapidly between seven to nine months old. Ms P’s baby was in this age range. Babycentre.com guidance for a seven-month old baby says, ‘Your baby is most likely trying to move however they can, rolling both ways, pulling up into a seated position, even trying to crawl… Once your baby can sit well without support, they will figure out how to get on their hands and knees and rock back and forth. Then they will figure out how to move forward and backward by pushing off with their knees. Not all babies crawl the standard way, some prefer to push themselves around on their bellies or scoot on their behinds. Some babies never crawl and use other methods to get around instead.’
36. A baby’s head movement and muscle tone/neck control is expected to be progressing and at seven months the baby would be expected to be at a level a little further than that noted by the ED nurses.
37. We can see from the records the ED nurses recorded their concerns about the baby’s development while Ms P was in the ED. The nurses made appropriate referrals in line with its safeguarding policy. The safeguarding nurse explained the reasons for the referrals to Ms P. We have seen no sign that the nurses did anything wrong.
Reflux diagnosis
38. Records show that when Ms P went to the ED she complained of epigastric pain (pain in the centre of the abdomen just below the ribs), which had come on suddenly the night before. Staff noted she had a history of possible reflux.
39. Staff documented Ms P’s observations which showed no significant abnormalities. The ED doctor saw Ms P at 11.30am. The doctor noted her history of epigastric pain and that she had a similar episode of pain the year. That episode had been investigated with an MRI scan (a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body). It was noted doctors told Ms P at the time that she may have an ulcer. The ED doctor noted that she had not had a follow-up appointment for this.
40. Our consultant adviser said the ED doctor examined Ms P appropriately and recorded the examination. The doctor noted they found her abdomen was soft with mild epigastric and right upper quadrant tenderness (tenderness under the ribs on the right side). The doctor noted there was no positive Murphy’s sign (a specific test to look for the presence of gallbladder inflammation or swelling). They recorded a working diagnosis of possible reflux and arranged for blood tests and pain relief. The doctor documented the results of the blood tests, including liver function tests (this can help to diagnose certain liver conditions). The test results showed no significant abnormalities.
41. The doctor also noted that Ms P’s pain had gone away. It is also recorded in the nursing notes that Ms P had fallen asleep while she was waiting in the ED. The doctor wrote that Ms P could be discharged home with a GP follow-up and gave her advice about what to do if her condition failed to improve.
42. GMC guidance) states: ‘You must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must: a. adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social, and cultural factors), their views and values; where necessary, examine the patient b. promptly provide or arrange suitable advice, investigations, or treatment where necessary c. refer a patient to another practitioner when this serves the patient’s needs.’
43. This is what the ED doctor did. The doctor documented a working diagnosis of reflux and our consultant adviser says this fitted with Ms P’s symptoms and test results.
44. Staff recorded Ms P’s symptoms had settled after giving her mild pain relief and antacid treatment (antacids are medicines that reduce the acid in the stomach to relieve indigestion and heartburn).
45. We have seen no evidence of an inflamed gall bladder at the time of Ms P’s visit to the ED on 16 January 2020.
46. Records show the ED doctor took an appropriate history, examined Ms P and arranged for the relevant investigations and treatment in line with GMC guidelines. We have seen no signs that the ED doctor did anything wrong.
47. We understand Ms P’s distress and it is clear she is concerned about her care and treatment. We do not wish to lessen the impact she says the events had on her but we have seen no signs that the Trust did anything wrong. We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for this.