A young girl tragically died just hours after a doctor sent her home with a tummy bug, an inquest has heard.
Five-year-old Esma Guzel had been sent home by her GP but, when her condition deteriorated hours later, was told to seek further help. She was on her way to see another out-of-hours GP when she had a cardiac arrest and tragically died in the early hours of May 10, 2019.
It was later discovered that Esma had a rare health condition that was not found prior to her death and caused the cardiac arrest. Esma's pre-existing undetected condition, Congenital Diaphragmatic Hernia (CDH), could not be identified in pre-natal ultrasounds, and was also not diagnosed when Esma was seen by her GP the evening before she died, Hull Live reports.
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Esma's mum previously spoke to Hull Live in the immediate months after Esma's tragic death to help raise awareness of CDH. She said Esma had been acting 'normal' when she suddenly began to feel unwell.
"She came home from school and was normal, went to my mum’s for her tea and just said, ‘Nanna, I feel sick’ and she was sick at my mum’s house." The family made an appointment to see a GP on the evening of May 9, where an assessment made of Esma concluded the cause was likely a tummy bug, but advice was given to contact NHS 111 if the ill health continued.
Esma's mum then called 111 at 1.38am on May 10 and was advised to take her to an out-of-hours GP service in Beverley, Yorkshire. Tragically, by the time Esma and her dad reached the location, she had died. A doctor carried out CPR and Esma was taken to Hull Royal Infirmary, but it was too late.
A full day of evidence was heard at Hull Coroners' Court on Monday (21 March) at the inquest into her heartbreaking death. Independent expertise in court revealed that the cardiac arrest was as a result of CDH, and part of her bowel becoming stuck in a hole in her diaphragm.
At Hull Coroners' Court, David Crabbe, a consultant paediatric surgeon, made clear that the GP's assessment of May 9 could not have foreseen the cardiac arrest, and said he could not identify a specific trigger for why Esma's bowel deteriorated so quickly.
He explained that CDH is a condition which affects approximately 1 in 2,500 births and usually can be detected in ultrasound scans. Esma had a Bochdalek CDH, consistent with a late presenting condition, and radiology evidence indicated that it was simply not possible to have identified it on the three pre-natal scans.
If ever diagnosed, Esma would have been prepared for surgery and the outlook for late presenting CDH after surgery is excellent, the hearing heard. Dr Crabbe also stated that had Esma's cardiac arrest occurred in hospital, it was likely on the balance of probabilities that she would have survived.
The highest level response that the 111 call at 1.38am could have prompted was a Category 3 dispatch of an ambulance, which would have reached them within an average 120 minutes, but Esma died shortly after 2.20am.
Dr Lynette Hykin provided an independent assessment of the GP's interaction with Esma on May 9, after she had presented with abdominal pains and had been vomiting shortly after 5pm. The GP noted Esma was miserable but chatty and as part of her assessment, carried out an abdominal examination.
Esma's mum and the GP had different recollections as to Esma's body position when examined abdominally, with the GP recalling examining her flat on her back before she curled up onto her side. Dr Hykin said there were no GP assessment features that dictated hospital referral.
She expressed potential concerns of care falling below the standard of a reasonably competent GP with regard to assessment of the abdominal pain Esma suffered and the colour of the vomit, which worsened by the time of the 111 overnight call to dark brown from light. However, those concerns about the GP assessment fell away if the GP's recollections of it were found to be correct.
Assistant coroner Dr Dominic Bell expressed his gratitude to the Esma's parents, who were in court throughout the day's proceedings. He indicated that the inquest would resume on Wednesday afternoon with a conclusion expected.
"We are only moving towards the conclusion of the first part," he added, in a reference to separate Section 28 regulation proceedings concerning a report to prevent future deaths, set to take place in April.
CDH UK is a charity dedicated to raising awareness of and supporting those affected by Congenital Diaphragmatic Hernia. To find out more about the condition, visit their website here.
