Briony Klingberg, aged 10, died on 18 January 2015 following a week of illness, as a result of multi-organ failure caused by a herpes simplex infection. The Coroner found that a contributing factor to her death was the lack of continuous medical care as no single medical practitioner had an opportunity to observe the progress of Briony’s illness.

Background

On 11 January 2015, Briony became ill. Her mother assumed that she had a cold or a sore throat. On 12 January 2015, those symptoms remained.

On the morning of 13 January 2015, Briony’s mother, Mrs Klingberg, took her to her local general practitioner who diagnosed Briony with a viral infection and prescribed antibiotics. Her symptoms failed to alleviate and later that evening, she was conveyed to the Women’s and Children’s Hospital’s Emergency Department (a long drive away from the Klingberg household). At this stage, Briony was unable to swallow and drink, and for the first time, it was observed that she had painful open sores in her throat. It was expressed to Mrs Klingberg that Briony was well enough to be discharged, however, the hospital was willing to keep her for observation. Briony was discharged and Mrs Klingberg was told to bring her back if she “got worse”.

Over the next two days, Briony’s condition did not improve, but in Mrs Klingberg’s words, Briony did not get any worse and, therefore, they did not return to the Women’s and Children’s Hospital.

On the afternoon of 14 January 2015, Briony was conveyed to the much closer Mount Barker Hospital. Mrs Klingberg advised the doctors there about the history of Briony’s symptoms and the visit to the Women’s and Children’s Hospital. Following the prescription of medication to alleviate the diagnosed symptoms of a virus and infection, Briony was discharged. The doctor asked Briony and Mrs Klingberg to return again on 15 January 2015, which happened as Briony’s symptoms did not alleviate.

On 16 January 2015, Mrs Klingberg contacted her parents’ family doctor, Dr Henrich. Mrs Klingberg again recounted the history of Briony’s symptoms and treatment. Dr Heinrich took a blood test and gave Briony strong antibiotics, diagnosing her with an infection and possible glandular fever. Briony continued to remain ill throughout the day. Dr Henrich called back that afternoon with what he described as an “odd” blood test result.

On 17 January 2015, Dr Heinrich called to see how Briony was. Mrs Klingberg said that Briony was getting worse and Dr Heinrich advised her to take Briony to the Women’s and Children’s Hospital, which she did straight away. Upon arrival at the hospital, Briony had a seizure and passed away in the early hours of 18 January 2015 from widespread liver necrosis from herpes simplex virus (HSV) infection.

Continuity of care

Throughout the period 11 January 2015 to 18 January 2015, Briony was attended to by two general practitioners and staff of the Women’s and Children’s Hospital and Mount Barker Hospital.

During this weeklong period, no single medical professional was in a position to observe the progression of Briony’s condition.

The Coroner opined that if Briony had re-presented to the Women’s and Children’s Hospital within 24 hours, this would have likely catalysed further action from the Hospital as the staff would have had the benefit of contemporaneous clinical notes from the previous night. 

When asked why she did not bring Briony back to the Women’s and Children’s Hospital, Mrs Klingberg stated that she did not get the sense that Briony was getting “worse”, but was instead not improving.

Coroner’s recommendations

In circumstances where children, parents, and families are inconsistent in their dealings with medical practitioners, the Coroner impressed the importance of encouraging parents to have the confidence to return to the one practitioner or health service in order to maintain continuity of care.

The Coroner recommended a campaign to explain to parents and carers the importance of continuity of care and the risks of breaking that continuity in circumstances where a patient is getting worse or not getting better.

Comment

This Inquest shows the importance of continuity of care in the health and allied health systems, particularly in relation to children and the elderly. It also highlights the importance of medical practitioners taking detailed and contemporaneous clinical notes to assist the continuity of care process and identify other practitioners they may need to contact.

More broadly, the Inquest is also a timely reminder that families, parents, and carers are often deferential to medical practitioners’ advice and a return should be encouraged where there is any doubt about a patient’s condition.