Nine-month-old died on same day of discharge from hospital

Lucas Thomas Munslow, from Flint, died on May 18, 2019, with a provisional cause of death given as acute bacterial meningitis following a post-mortem examination.

At the first day of the full inquest into his death, held in Ruthin today (November 21), it was heard that there were concerns regarding diagnosis and the care and treatment of Lucas prior to his death.

Kimberley and Nathan Munslow, Lucas’ parents, said in a statement that they were “taken aback that a doctor didn’t even remove Lucas from his buggy to examine him”.

The inquest heard that, though Lucas’ birth was “largely unremarkable”, he developed health issues between February and May 2019, including a cough, a watery eye, and repeated vomiting.

On May 15, he was taken to visit his GP, Suganya Prabhaker, at The Laurels Surgery in Flint, having recorded a temperature of 39°C the previous evening.

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He vomited while at the surgery, and was “gagging and heaving all the time”, but Dr Prabhaker found that his chest was clear and that he had likely developed a viral infection.

The following day, Lucas’ parents noticed he was “very tired” but that his temperature seemed “more normal”, though they said his eyes “turned in, as though he was cross-eyed”.

On May 17, his grandmother noticed his eyes had “glazed over”, and that his hands and feet were “freezing cold”, so his parents took him to Glan Clwyd, fearing that something was “really wrong”.

It took about 30 minutes until Lucas was checked by a triage nurse, before another three-hour wait for him to next be seen to.

Medical emergencies elsewhere in the hospital caused further delays, and it was not until just after midnight that a doctor, Kayode-Awe Olugbemiga, saw to him.

Dr Olugbemiga found that Lucas had likely developed viral tonsilitis, and another doctor, later asked to give a second opinion, agreed.

But, Lucas’ parents claimed, “at no point were any full checks done… we were released at about 1am (on May 18) without what we felt to be proper consultation”.

His parents made a 999 call at about 6.30pm on May 18 when Lucas “went stiff” and “staring into space”, appearing unresponsive.

After his condition continued to deteriorate that night, they said, “our beautiful baby boy passed away at 11.50pm”.

Dr George Kokai, a pathologist at Alder Hey Children's Hospital, found evidence of bacterial infection and meningitis when undertaking Lucas’ post-mortem examination.

As Lucas’ GP, Dr Prabhaker told the inquest that she had seen him “quite a few times”, and that when he attended the surgery on May 15, he had a high heart rate of 156bpm.

She suspected at that point that he had a viral infection, not considering sepsis or meningitis, and was told via a follow-up phone call later that day that he had “perked up”.

During this call, she said she was not told that this temperature remained 39°C; had she been informed of this, she said, Lucas would have been asked to return to her surgery.

Michelle Powell, a senior sister in Glan Clwyd’s emergency department at the time, triaged Lucas upon his arrival at the hospital on May 17.

She considered his temperature at that time of 39.6°C concerning, but triaged him in the “yellow” category – meaning that he ought to be seen within the next hour.

Mrs Powell said it did not seem appropriate to categorise Lucas as “red” (urgent), given he seemed “alert and OK at the time”.

But on reflection, she said she should have put Lucas in the “orange” band (to be seen within the next 10 minutes).

“Had I had any concerns with Lucas, I would have spoke to a doctor directly, for him to be seen sooner, or arranged for him to be put into an appropriate bed space,” she said.

Carol Stevenson, an advanced nurse clinician at the hospital’s emergency department, then saw to Lucas in the triage room.

She examined him, and found him “very, very pale”, with a heart rate of 152bpm, adding that it was difficult to determine his respiratory rate as he was distressed.

Mrs Stevenson noticed Lucas had a squint in both of his eyes, and that both of his pupils were inverted, but said she did not place much onus on this after being told by his parents that this was not new.

Though she did not delve into how old this squint was, or if it was congenital, she said that, in hindsight, she would have asked such questions.

Concerned that Lucas had developed febrile convulsion (fever often from infection occurring in young, healthy children), she referred him to the paediatric ward for further assessment, documenting his squints.

Dr Olugbemiga, working as a senior house officer at Glan Clwyd at the time, reviewed Lucas formally at about midnight that time.

He felt that Lucas had developed tonsilitis, given he found his tonsils to be red upon inspection.

Meningitis “was on my radar”, he said, but he added that he did not see any signs to support such a diagnosis, nor did he detect any “red flags” whatsoever.

Dr Olugbemiga also contested the claim that Lucas was not removed from his pram for examination, saying he observed him while on his mother’s lap.

He said he was unaware of any squint, and discharged him at about 12.20am on May 18.

Though, he admitted that, had he noticed or been made aware of Lucas’ squints, or references to clenched fists and periods of fitting, together with his high temperature and lethargy, he may not have discharged him.

“That information should have been available to me,” he said.

Dr Solabomi Alalade, senior to Dr Olugbemiga, then reviewed him Lucas prior to his discharge.

She considered the slight reduction in his temperature and heart rate to be “good signs”, adding that he appeared alert, conscious and not irritable when she examined him on a couch.

Though Dr Alalade said she also found no signs of meningitis, she said Lucas “wouldn’t have been going home” when he did if she had noticed a persistent squint.

Ultimately, she agreed with Dr Olugbemiga’s conclusion that Lucas had developed viral tonsilitis.

John Gittins, senior coroner for North Wales East and Central, will conclude the inquest tomorrow.