The Penningtons Manches clinical negligence team has settled a claim against Yeovil District Hospital for the mismanagement of diabetes which led to the death of a patient.

The team was instructed by the family of an elderly lady who was initially admitted to hospital several months prior to her death and diagnosed with metastatic neuroendocrine tumours. She was subsequently readmitted to hospital with complaints of abdominal pain, vomiting and drowsiness and was kept in for observation. At the time of admission, the differential diagnosis given was of sepsis and she was treated with antibiotics for possible lung infection.

She was known to have Type 2 diabetes and, as well as being treated for possible sepsis, was meant to have her diabetes managed to prevent any hypoglycaemic episodes. It was recommended that her blood sugars were kept between 8 – 14 mmol/L and regular bedside glucose measures were meant to be taken.

During the course of her admission, the patient was noted to be feeling better and clinicians treating her recommended that she may benefit from having rehabilitation. She was placed on a waiting list to be discharged to a local rehabilitation hospital to continue her recovery.

Unfortunately, her condition worsened after this decision was made and she was experiencing extreme fatigue and hallucinations. During a routine check-up by the diabetes in-patient specialist nurse, it was noted that she had severe hyperglycaemia which had lasted for approximately three days. Her bedside glucose measurements were noted to have risen to more than 30 mmol/L but had not been treated. The clinician commenced a variable rate insulin intravenous infusion but sadly her condition continued to deteriorate and she passed away.

Following the death, a coroner’s post mortem was performed and an internal investigation was instigated by the hospital. As part of this investigation, a number of issues were identified which included the failure to address the hyperglycaemia.

When Penningtons Manches was first instructed, the family of the deceased were concerned that her diabetes had been poorly managed and that she would not have died if it had been appropriately managed. Following receipt of the medical records, expert evidence was obtained from a diabetologist who concluded that it was negligent to fail to manage the diabetes and to take appropriate action with the results. The treatment received by the deceased once the hyperglycaemia was noted was inappropriate. The expert was of the opinion that the development of severe hyperglycaemia would have disadvantaged the deceased in terms of possible recovery and played a part in her subsequent deterioration and death.

Following receipt of the expert evidence, a letter of claim was served upon the defendant trust and matters were dealt with by the NHSLA. During the course of the trust’s investigations, expert evidence was obtained and a full admission of liability and causation was made when the letter of response was served. The defendant made a formal Part 36 offer and, after some negotiation, a favourable settlement was reached on behalf of the deceased’s estate.