4 days ago
Doctor guilty of misconduct over girl's death that led to Martha's Rule
A doctor has been found guilty of misconduct for his failings in the treatment of a girl whose death led to Martha's Rule.
Prof Richard Thompson failed to escalate the treatment of Martha Mills, 13, before she died from sepsis in 2021, a disciplinary panel found on Monday.
The teenager's death prompted the introduction of Martha's Rule, which gives patients and families the right to a second medical opinion if their own or a loved one's condition deteriorates in hospital.
Martha died from sepsis after doctors missed its symptoms and did not heed warnings from her parents that her condition was rapidly deteriorating.
A medical tribunal in Manchester has now ruled that Thompson committed 'misconduct which impairs his fitness to practise' during her treatment.
The Medical Practitioners Tribunal Service (MPTS) panel found that the doctor, who was the on-duty consultant at King's College hospital (KCH) in London, had made 'particularly grave' failings.
It ruled that Thompson should have referred Martha to intensive care on Aug 29 2021 and that he had failed to conduct an in-person assessment of her condition.
The doctor was on-call at home for part of the day.
Robin Ince, the chairman of the panel, said there was 'no sound reason' why Thompson did not assess Martha's condition himself.
'The tribunal was of the view that, as more serious and unexplained factors had come into play, there were clear points (at 17.00 and 20.30) when Prof Thompson should have taken action not only to see Martha himself but also to refer Martha to PICU (paediatric intensive care unit) and these combined failures to do so makes them more serious,' he said.
'The tribunal appreciated that it was assisted by hindsight but concluded that there were sufficient adverse clinical indicators at the time of something unexplained going on such that direct review and escalation to PICU was required.'
Martha was only transferred to intensive care on August 30, by which point she had septic shock.
She died from sepsis on August 31 at Great Ormond Street hospital (GOSH), where she had been transferred.
A coroner ruled in 2022 that she would have likely survived if doctors at KCH had identified the warning signs of the condition and transferred her to intensive care sooner.
The trust has since apologised for mistakes in Martha's care.
Martha was in hospital with a pancreatic injury after a fall from her bike while on a family holiday in Wales. King's is a specialist national referral centre for children with pancreatic problems.
'Gravity of mistakes'
In a statement, Merope Mills and Paul Laity, Martha's parents, welcomed the recognition of the 'gravity of mistakes' made before her death.
'It is important to us that allegations denied have been found proved and the gravity of mistakes that led to our daughter's preventable death has been recognised,' they said.
'We will always have in our minds the failures of culture, training and policy on Rays of Sunshine ward at King's College Hospital, as well as the responsibility of individuals. We'd like to thank all of the thoughtful doctors who have helped us to understand what happened to Martha.'
Thompson's sanction will be determined at a separate hearing on Tuesday.
Mr Ince said the panel believed he had been 'remediated' and that it was 'highly unlikely that anything like this will ever happen again and there is no current impairment of Prof Thompson's fitness to practise on this basis '.
But he added: 'The tribunal concluded that the misconduct was such that a finding of impairment was required to uphold public confidence in the profession as well as uphold proper professional standards, and that it would be undermined if no finding of impairment were found.'
