‘Brave and beautiful’ baby girl died after doctors ‘repeatedly missed vital signs’
A BABY girl died from a rare cancer after doctors repeatedly missed signs of her illness, a sheriff has ruled.
Jessi-Jean MacLennan passed away in Glasgow's Royal Hospital for Children in November 2019 aged 20 months.
She had been battling a form of kidney cancer known as Wilms tumour - a rare childhood condition with fewer than 100 cases every year in the UK.
Current research shows that even an advanced stage Wilms tumour has a cure rate of 85 percent.
The Lord Advocate Dorothy Bain said Jessi's death gave rise to "serious" public concern and ordered a fatal accident inquiry be held at Inverness Sheriff Court.
Sheriff Eilidh MacDonald has now ruled medics failed to properly recognise her "perfectly treatable" illness after her mum Sara raised the alarm about her condition.
Mrs MacLennan had noticed Jessi's appetite had decreased in July 2019 and took her to Culloden Surgery in Inverness with her concerns, which also included a high temperature.
Dr Toby Gilbertson examined her on October 3 but took no further action.
Jessi was seen a further four times by doctors over persistent symptoms, which included a lump on the left side of her stomach and a blood clot in her nappy.
At one point, Mrs MacLennan, a mum-of-three, contacted NHS 24 and Jessi was seen by Dr Abdul Jabber Bhutto at Raigmore Hospital in Inverness, who said she was suffering from constipation.
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In November 2019, Jessi collapsed at home after vomiting and was found to be "blue, cold and unresponsive" by paramedics and taken by air ambulance to Glasgow.
She passed away days later in hospital after suffering a cardiac arrest on November 25.
Expert witness Dr Norman Wallace wrote a report for the inquiry and stated Jessi should have been referred for specialist treatment at the start of October 2019 when she presented as "very unsettled".
Professor Hamish Wallace told the probe if Jessi had been properly examined, "cure was not just possible but probable".
NHS Highland told the inquiry it had taken steps to improve its paediatric care following the youngster's tragic death.
In a written ruling, Sheriff MacDonald said repeated failures to spot Jessi's illness had led to her passing.
But she said she accepted NHS Highland made the necessary improvements and made no recommendations for changes.
The sheriff said: "Professor Wallace’s evidence was clear - Wilms’ was a perfectly treatable disease once diagnosed.
"It was curable, and in Professor Wallace’s opinion, if diagnosis had been made at any of the 'missed opportunities' from October 3, 2019, until 6 November, it was his view that cure was not just possible, it was probable."
'Perfectly treatable'
She concluded: "The evidence clearly shows that Mrs MacLennan did absolutely everything she could to try and get the help her daughter needed from the doctors; she could have done no more.
"All participants in the inquiry recognised the enormity of the family’s loss and I extend my deepest condolences to Mr and Mrs MacLennan and the family."
A spokesperson for NHS Highland said: "NHS Highland participated fully in the FAI and we acknowledge the findings laid out in the determination.
"Since this tragic case, a number of improvements and additions have been made to develop the service within the Paediatric Assessment Unit at Raigmore Hospital.
"We would like to pass on our sincere condolences to Mr and Mrs MacLennan and their family."
Wilms tumours, also called nephroblastomas, are a type of kidney cancer that mainly affect children - about 85 every year in the UK.
According to CRUK, most tumours are quite large by the time they are found, often bigger than the kidney itself.
The swelling is usually painless, and parents might notice a lump in their tot's tummy when bathing them or if they jump a nappy size.
Other less common symptoms include:
- Bleeding inside the tumour causing pain
- Blood in the urine – found in 20 per cent of children with a Wilms tumour
- Raised blood pressure
- High temperature
- Loss of appetite
- Weight loss
- Feeling or being sick
- Shortness of breath and cough (only if the cancer has spread to the lungs)
- Generally feeling unwell
- Looking pale due to a low number of red blood cells (anaemia)
- Being irritable due to their tummy feeling uncomfortable
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CRUK emphasised that Wilms tumour is very rare and that it doesn't mean your child has one if they're suffering from these symptoms.
But it's important to take them to see a GP if you spot any of these signs in case it is something serious.