Girl, 10, left in agony
Becky endured a nightmare of pain until staff at Starship finally ordered the scan that identified the cause. Her family believe the health system owes her an apology, writes Hannah Martin.
A 10-year-old girl who endured ‘‘excruciating’’ abdominal pain for more than a month was not given a scan which could have identified the issue sooner, say her parents.
Ben and Tali Rose took daughter Becky – writhing in pain and ‘‘screaming uncontrollably’’ – to Starship Children’s Hospital’s emergency department seven times between September and October.
Six weeks after the first visit, a CT scan showed Becky’s bowel had perforated and infectious fluid had pooled in her pelvis.
Her parents say Auckland District Health Board’s repeated failure to perform a scan sooner caused Becky harm. However, the DHB maintains that Becky was scanned at the appropriate time.
In August, Becky was diagnosed with Crohn’s disease, an inflammatory bowel condition which causes abdominal pain, severe diarrhoea, weight loss and malnutrition.
On September 3 Becky started screaming and complaining of pain in her pelvis. It was different to any pain she’d experienced with her Crohn’s. She was also experiencing intense discomfort when passing urine.
Becky was so distressed that she was taken to Starship’s ED in an ambulance.
She was given heavy-duty painkillers morphine and tramadol. Doctors gave her an ultrasound, looking into the possibility she might have appendicitis or a flare-up relating to Crohn’s.
After five days in hospital, including her 10th birthday, Becky and her family were sent home without a solid answer.
It was ‘‘absolute torture’’, mum Tali Rose told the Sunday Star-Times.
‘‘I cannot describe the pain she was in . . . doctors [at Starship] were shocked.’’
Each time they visited hospital, the Roses were told the pain was related to Becky’s Crohn’s. But there was no MRI or CT to investigate the source.
On October 3, the hospital administered the medicationHumira. Shortly after, Becky fell to the floor in agony.
Her mother carried her back to ED, where she was admitted and given fentanyl.
Just the day before, via an email to the Roses, a specialist at Starship had recommended Becky have a pelvic MRI to assess her pain passing urine.
In the email, the doctor told the Roses he was concerned about Becky’s pain, and had personally ordered the scan. But it did not eventuate.
Between September 30 and October 3 DHBemployed radiographers – who perform X-rays, MRI and CT scans – were on intermittent strike.
The withdrawal of labour forced hospitals around the country to reschedule patients and delay elective procedures, administering scans for only the most urgent cases.
The Roses say hospital staff told them the strikes were affecting access to scans, so they booked another MRI through the private system as a back-up.
The earliest MRI they could get was October 17. In the meantime, they waited.
Becky ended up in ED another handful of times in the week that followed. The Roses kept asking for the MRI ordered earlier in the month, to no avail.
Then, on October 16, Tali said ‘‘everything in her body broke down’’.
Becky had been vomiting for hours when, almost unconscious, she was wheeled to the resuscitation room in the Starship ED. Doctors worked for an hour to stabilise her, including emptying her stomach, Rose said.
During the ordeal an ultrasound showed fluid in her pelvis and finally a CT scan was ordered. It revealed a perforated bowel.
A perforation (a hole in the lining of the gastrointestinal tract) can cause bowel contents to spill into the abdomen, leading to infection and potentially sepsis.
Becky’s bowel was also blocked, sending its contents back up into her stomach.
The family went on to describe how doctors also found a ‘‘collection’’ of fluid in her pelvis, which
‘‘Everything in her body broke down.’’ Tali Rose
could have been caused by the perforation or inflammation from the Crohn’s.
Doctors told her parents that Becky’s immune system went into overdrive trying to contain the fluid, contracting the muscles around it to keep it in place – causing the pain.
Now the fluid is being treated with antibiotics, Becky’s condition is improving. The pain which drove them to ED most nights has disappeared, her mum says.
She remains in hospital, and on Friday had her first solid food in weeks. Her condition also delayed her Crohn’s treatment, which finally resumed on Friday morning.
Ben Rose, a senior executive at Stuff, and Tali maintain this could have all been avoided had a scan been carried out sooner.
They say they are not critical of the care their daughter received, but say the limited access to treatment due to strike action put her in a ‘‘lifethreatening situation’’.
Staff had gone ‘‘above and beyond’’ in their care of Becky, which the Roses say they were ‘‘very grateful’’ for, but believe things did not need to get to this point.
‘‘Had a scan been done earlier things would have been different,’’ Tali said.
The Roses want Auckland DHB to take responsibility for not scanning sooner, and apologise to Becky.
They also want to see the DHB improve its processes around assessing the seriousness of a patient’s condition during strike action.
In a statement, Starship’s director of child health, Mike Shepherd, said he could not comment on the details of Becky’s care or condition for ‘‘ethical and privacy reasons’’.
However, he said the impression her family received from medics, which alleged strike action affected the timing of Becky’s scans, was ‘‘not accurate’’.
Becky received MRI and CT scans within the ‘‘appropriate clinical timeframe’’.
Perforations and bowel obstructions were known complications of Crohn’s disease and could occur at any time. They were difficult to predict, difficult to prevent, and did not always show on scans, Shepherd said.
Diagnosis was complex, and scans were only part of the process. If doctors suspected a patient has a perforation they consulted with surgical colleagues and arranged further tests, including scans as appropriate.
Shepherd said it was not unusual for clinicians to be treating children in severe pain caused by conditions such as Crohn’s.
‘‘It is a very complex disease which can cause severe pain and it is of course never easy to see a loved one in pain.
‘‘We have great sympathy for Becky and her family,’’ he said.