By court reporter Candice Prosser.
A 10-year-old girl’s death from a herpes infection, which multiple doctors failed to diagnose, has led a South Australian coroner to urge parents be better educated about the effects of the virus and the need for continuity of medical care.
Briony Caitlin Klingberg died two years ago after she had been ill for a week.
The court heard her mother had taken her to the Adelaide Women’s and Children’s Hospital, Mount Barker Hospital and the family GP ahead of her death.
Coroner Mark Johns said the family GP had not taken appropriate action, but he also urged there be a community campaign to ensure parents recognised the importance of continuity of care.
Briony died of multiple organ failure, the court heard, and had been a “healthy and strong” child before she became ill.
Her mother initially took her to the Women’s and Children’s Hospital, where a senior doctor offered the girl could be kept in for observation or taken home if the family preferred.
“She said that she and her husband had the sense that they should not come back unless Briony got worse,” the coroner said in his findings.
“As a result, they would decide not to return to the Women’s and Children’s Hospital. Instead they took her to the local hospital at Mount Barker on the assumption that they would advise to take Briony to the Women’s and Children’s Hospital if that was necessary.”
A doctor there diagnosed a virus or infection, prescribed prednisolone and asked the girl be brought in again the next day. At that visit, he formed the view she was slightly better.
“Mrs Klingberg said that she did not believe that Briony was better, but wanted to believe that it was true,” the coroner said.
“She did not argue and accepted the doctor’s advice to take Briony home and keep up the fluids and medications, including the prednisolone.”
Girl collapsed outside emergency department
The family GP, Dr Heinrich, gave the girl an injection of antibiotics a day later and thought her symptoms might have been due to glandular fever, Mr Johns said.
He took a blood test and promised to ring the parents with the result.
The court was told those results were “odd” and, given the girl remained unwell and unable to urinate, the doctor then advised she be taken to the Women’s and Children’s Hospital.
The child collapsed outside the emergency department, leading to a “code blue” alert, the coroner said.
She died while in intensive care the next day and a liver biopsy revealed widespread necrosis from herpes simplex virus (HSV) infection.
Mr Johns said the senior doctor at the Women’s and Children’s Hospital later conceded he should have made a different diagnosis, but would not have greatly changed Briony’s treatment.
“Dr Gill said that he has seen HSV many times and that it is a common illness, although less so in Briony’s age group,” Mr Johns said.
“He said that he thought that the small ulcers that he saw in Briony were slightly unusual, but not outstandingly so, and were consistent with pharyngitis.”
The coroner said Dr Say at Mount Barker Hospital had been “caring and conscientious” and was “clearly very distressed about Briony’s tragic death”.
But he was critical of the family GP, although acknowledged it was probably already too late to have saved the girl’s life.
“Dr Heinrich was not an impressive witness. He failed to take proper notes, he failed to take observations of Briony during the consultation,” the coroner said.
“He took delivery of verbal messages via telephone about extremely important and significant blood results without seeing the need to write them down or even attend at his rooms, which were not very far away.”
Mr Johns said continuity of care was important and, given the variety of doctors the girl had been taken to, “no single medical professional had an opportunity to observe the progress of Briony’s illness”.
“In making these observations I stress that I am not being critical of Briony’s mother and father in any way whatsoever,” he said.
“It is important that the Women’s and Children’s Hospital and all other practitioners dealing with children try to encourage parents and carers to have the confidence to return in order to avoid discontinuity of care.”
This post originally appeared on ABC News.
Featured image: Bridget Klingberg and her husband took their daughter to multiple doctors. Image via ABC News: Candice Prosser
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