Martha's Rule: Family's anguish as nine-year-old daughter with Strep A dies after tonsilitis diagnosis
A hospital doctor misdiagnosed Strep A as viral tonsilitis - with tragic consequences
A senior coroner has urged the government to enact a 'Martha's Rule' to allow parents to get a second opinion from medics after a nine-year-old girl sent home from hospital with suspected tonsilitis died a day later from bacterial infection Strep A.
The emotional family of Riya Hirani said they felt they had been 'let down’ by the NHS after their daughter was discharged from hospital the day before going into cardiac arrest, despite them asking doctors for antibiotics.
And Senior Coroner for Inner North London Mary Elizabeth Hassell said 'beautiful' Riya would have survived had she been given the antibiotics.
The case comes as Health Secretary Steve Barclay also says he will back the campaign for a Martha's Rule.
But Riya's organs which were donated following her death have saved four lives, her family said.
Senior Coroner Hassell revealed she would be penning A Prevention of Future Deaths Report urging government ministers to approve ‘Martha’s rule’.
An inquest held at St Pancras Coroner’s Court heard that Riya, described by heartbroken mum Geeta and dad Mukesh as ‘mature’ and ‘wise’, first became unwell a few days before Christmas last year.
Her worried mother rushed her to hospital, noting she had never seen her daughter this ill and that she was having trouble breathing.
But Riya, who had celebrated her ninth birthday just weeks before, was sent home by doctors at Northwick Park Hospital in Harrow who misdiagnosed her symptoms as viral tonsilitis - despite her mother’s insistence it was something worse.
The day after, as they were preparing to rush back to hospital after her symptoms worsened, Riya suddenly collapsed and fell into cardiac arrest.
She died five days later at Great Ormand Street Hospital (GOSH), with her organs donated to save the lives of four others - two of whom the family know.
The coroner, after hearing hours of medical evidence from several doctors who cared for Riya, concluded the young girl would have survived had she been given antibiotics when she was first seen in December last year.
She said: “Riya died from a Group A streptococcus infection. I accept that evidence. The night before her final presentation, Riya was brought into hospital by her mum.
“I am satisfied that at the point she was brought in, she was showing signs and symptoms of a bacterial infection and should have been recognised as a sick child, admitted and treated with antibiotics.
“I don’t know what would have happened for certain, but I am satisfied that, on the balance of probabilities, if Riya had been appropriately treated she would have survived.”
Ms Hassell added to Riya’s sobbing parents: “I am so sorry to have to say that to you.”
The inquest heard Riya, described as ‘strong, healthy and active’ by her family, caught a ‘winter bug’ in December last year.
She went to her mother’s work Christmas party on December 22, but became ‘subdued’ during the evening, complaining that her neck was hurting.
When she began struggling to speak later that evening, her mother called 101 who advised her to take Riya to A&E.
When they were finally seen after around two hours, Riya’s heart rate was found to be high and she was asked to stay for observations.
Not long after, however, Dr Mahmud Benoune sent the young girl home with a diagnosis of tonsilitis.
Dr Benoune told the inquest he prescribed a throat spray, but due to the late hour, Mrs Hirani was unable to buy this until pharmacies reopened later in the morning.
He also handed them a leaflet about tonsillitis and advised Riya’s mother to give her paracetamol or ibuprofen as required and to return if symptoms worsened.
Dr Benoune, who has since left Northwick Park Hospital, admitted that, although he noticed Riya’s tonsils were inflamed, he was satisfied they were not ‘severely inflamed’ - one of five key criteria indicating Strep A.
Riya presented two of the five indicative symptoms - a fever and symptoms persisting for more than 24 hours.
Struggling to contain her tears, Mrs Hirani told him she had made it abundantly clear to the doctor that her daughter was struggling to speak, which may again have pointed towards Strep A.
She told Dr Benoune: “She was struggling to speak. I said that at every point in A&E. I said she couldn’t get her words out. You could see her tonsils were swollen. They were very red and that’s why you gave the diagnosis of tonsilitis.”
Riya’s dad Mukesh, a company director, added: “Numerous times we asked about antibiotics. She’s a nine-year-old girl - or, she was a nine-year-old girl. You sent her home with no medication.”
Dr Benoune, after being told this contradicted his evidence, replied: “I don’t know… It’s really red, but does not mean severely red. Sometimes we can't predict the future."
The evening after she was sent home, however, Riya suddenly collapsed as the family was preparing to return to hospital, complaining she couldn’t breathe.
Paramedics arrived within two minutes at the family’s home in Stanmore, West London, and gave her CPR and two shots of adrenaline, and eventually got her heartbeat stable.
She was rushed back to Northwick Park Hospital where it was later confirmed she had been in cardiac arrest for around 22 minutes.
Riya was transferred to GOSH in the early hours of the morning, where viral tests later showed she had both influenza B and Strep A.
She died on December 28, around five days after being sent home from hospital after first having her symptoms checked.
GOSH doctor Quen Mok, when questioned as to whether Riya would have survived if she would have been given antibiotics when she first presented her symptoms to doctors, replied: “At least it would have given her a chance.”
Describing her ‘smart’ daughter, Mrs Hirani, a senior business analyst, said in a statement: “Riya was an IVF baby.
“She loved a song and dance and to do arts and crafts. She was strong, healthy and very active. She loved writing notes to friends and family and spent hours with her little sister playing with Lego. We have now lost our beautiful daughter over a poor decision made the night before.
“There are no words to describe how we feel. How can a young, physically fit child lose her life like this? We feel we have been truly let down by the NHS.”
Senior Coroner Hassell told the inquest she would write two prevention of future death reports: one to Northwick Park Hospital to prevent any other children succumbing to a similar fate as Riya, and another to Health Secretary Steve Barclay, advising him to push ahead with ‘Martha’s Rule’.
The legislation, which would make it easier for patients to get a second medical opinion if they believe their concerns are not being treated seriously enough by medical staff, was inspired by Martha Mills, who died in hospital after doctors failed to admit her to intensive care.
Ms Hassell said: “If [Riya] had been treated appropriately, she probably would have survived.
“I am so sorry for the loss of your beautiful girl.
“It has been in my mind to make a Prevention of Future Deaths Report to Northwick Park Hospital.
“I am also going to make a second report to the relevant minister or Secretary of State for the development of a rule that allows a patient or their family to seek a second medical opinion.
“I think it would be appropriate for me to make a report to add weight to the evidence already in the public domain.”
Riya’s family said after the inquest that a charity ball will be held on December 1 this year, to mark what would have been her tenth birthday.