Jury concludes 5-year-old girl died from natural causes, contributed to by neglect at hospital in Leeds
Esta High died at Leeds General Infirmary in November 2023, days after she was taken into the emergency department with a high temperature
Neglect contributed to the death of a five-month-old girl who died from meningitis after a series of missed opportunities in hospital to save or prolong her life, an inquest jury has found.
Esta High died at Leeds General Infirmary in November 2023, days after she was taken into the emergency department with a high temperature and vomiting.
Her parents Lynsey Carr and Leon High claimed doctors missed vital chances to test for a bacterial infection and start vital antibiotic treatment, and Ms Carr told an inquest at Wakefield Coroner’s Court how their concerns were ignored until it was too late.
On Tuesday, an inquest jury of five women and six men concluded that Esta “died of natural causes which was contributed to by neglect” and that different care would probably have “saved or prolonged her life”.
The jury said opportunities were missed as doctors stuck with a diagnosis of Covid after she tested positive for coronavirus.
There was no dispute that Esta’s cause of death was streptococcus pneumoniae meningitis, the court heard.
Lawyers for Leeds Teaching Hospitals NHS Trust admitted during the inquest that there had been missed opportunities to diagnose the bacterial infection which causes meningitis and give Esta antibiotics.
Ms Carr told the jury how Esta was a “happy, healthy, smiling girl” before she became ill on October 31 2023.
Her parents took her to Leeds General Infirmary with a high temperature and vomiting, and she later tested positive for Covid.
Ms Carr told the inquest how the family, from Leeds, was 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 due to the Covid risk than listening to her parents.
Ms Carr said she and Mr High refused advice from doctors to take Esta home as she had a temperature that soared to over 40 degrees and she would not stop vomiting.
She said her daughter developed a rash and her arm started shaking, which she feared was a seizure.
Mr High filmed Esta’s arm movements and this was shown to the jury.
Ms Carr told the jury “we were extremely worried” and “we kept asking for help”, but “staff were rude and don’t listen to our concerns”.
She said that Esta’s time on the CAT unit was “15 hours that were filled with missed opportunities”.
By late afternoon on November 2, Esta could not be roused and the jury heard how scans and other tests showed evidence of meningoencephalitis and streptococcus pneumoniae. Esta was taken to intensive care and attempts were made to save her life, but Ms Carr said it was all too late.
She died on November 6.
Ms Carr told the jury: “Unfortunately, as our daughter had been left untreated for 55 hours, it was too late to save our darling girl.”
She said her daughter was “bright, beautiful and perfect from the first moment”, and “when she arrived, she completed us”.
She added: “Her smile lit up every room – especially in the mornings when she woke as if full of joy just to see us again.
“She brought happiness everywhere she went.”
Ms Carr said: “She made us a family of three and we were excited for every moment ahead.
“In just five months, Esta touched the lives of everyone who met her.”
Dr Elizabeth Garthwaite, Chief Medical Officer at Leeds Teaching Hospitals NHS Trust, said:
“We are deeply sorry that we failed Esta and her family, and offer our sincere and heartfelt condolences to Lynsey and Leon following the tragic death of their daughter.
“We are grateful to the Coroner and jury for their careful consideration of the circumstances surrounding Esta’s death. We recognise the immense pain and loss experienced by Esta's family and acknowledge that nothing can change what happened or lessen the grief they continue to live with every day.
“We fully respect the jury's findings and the Coroner's decision to issue a Regulation 28 Prevention of Future Deaths Report. We recognise that serious failures occurred in the care provided to Esta and that these failures had devastating consequences.
“We take the concerns raised by the Coroner extremely seriously and will carefully consider the report's findings and recommendations. We are committed to responding openly and fully, and to taking any further action necessary to improve patient safety.
“We have already taken a number of steps to strengthen our services, including improving the recognition and management of deteriorating children, enhancing staff training in paediatric sepsis, strengthening escalation processes and implementing Martha's Rule to help ensure concerns raised by patients and families are heard and acted upon. We will continue to review our practices in light of the Coroner's findings and any additional lessons identified.
“We remain committed to learning from what happened to Esta, listening to patients and families, and doing everything possible to provide safe, compassionate care for every child and family entrusted to our services.”