In July 2015 a three year old boy was admitted to a Suffolk Hospital after suffering burns to his body. Shortly thereafter boy developed a fever and was returned to the hospital two days later where he was told he had tonsillitis and he was prescribed antibiotics. Unfortunately for the young boy he had developed toxic shock syndrome ("TSS") which was not diagnosed. As a result of the TSS the young boy underwent amputations which, included both legs below the knee.

The hospital which had failed to properly care for the boy has made an unreserved apology. Further, the trust has admitted liability for their breach of duty to the young boy and has made an interim payment of £50,000 to the boy's family while final settlement negotiations continue.

This leads one to ask what is TSS how identifiable is it?

TSS is the introduction of toxins to the blood stream which are produced during the colonisation of the Staphylococcus aureus bacteria. So in other words, when a person suffers from a burn, a trauma or a surgical wound the damaged areas of the skin may become covered by bacteria within 12-24 hours. It is the bacteria that creates toxins during their reproduction which enter the individual's blood.

TSS is a condition which is so rare A&E staff are only likely to encounter one or two cases in their career. This is a worrying prospect as it will most likely be A&E staff who will first encounter patients with TSS. Diagnosis of TSS is difficult as the symptoms do not manifest themselves all at once or early in development. Nevertheless, the development of TSS is correlated with recent, and occasionally known, events such as burns, trauma or surgical wounds which should prompt medical experts to explore the possibility of TSS.

How does the law approach any rare condition? Answer - the standard of care is that of a reasonably competent doctor according to a responsible body of like medical opinion. This allows a doctor to make a "reasonable mistake" and escape liability for it. At what point would a reasonable competent A&E doctor come to the conclusion that TSS was the most likely diagnosis despite the rareness of the condition? Every event will pivot on its own facts and evaluated by expert evidence and course there would be a point when the A&E doctor would consult specialists for a diagnosis.

The effects of TSS has the potential of life changing consequences and medical professionals have a duty to the patients and their families to prevent injuries to include amputation(s) and/or death.