Coroner advises medics ‘reflect’ on relaying news

A CORONER has asked for a neurosurgical team to reflect on how they communicate with patients after a child was told that she was about to have a hole drilled into her skull.

Assistant Coroner Karen Dilks said that staff working within the neurosurgical team at the Great North Children’s Hospital “think very, very carefully” about how their communication may be interpreted by a patient, particularly children.

It comes after an inquest heard that a 12-year-old girl who was about to undergo surgery to relieve pressure on her brain was allegedly told “we’re going to take you to theatre and drill a hole in your skull”.

Gemma Caffery, from Hamilton, Lanarkshire, died in the Paediatric Intensive Care Unit (PICU) at the Great North Children’s Hospital, at Newcastle’s Royal Victoria Infirmary on October 25, 2021.

She had been suffering from headaches which caused her to wake in the night and was admitted to hospital when her headaches became more severe while on holiday at Haggerston Castle, near Berwick, Northumberland.

She suffered seizures while in hospital and a decision was made for a procedure to monitor the pressure on her brain. This was followed by a craniectomy to remove a section of her skull.

Nithish Jayakumar, the neurosurgical trainee who operated on Gemma, told the inquest: “I went to speak to the family together and explained the procedure to mum and dad in the presence of Gemma so all would be aware of what we were planning to do, the risks and the aim of the operation.”

Assistant Coroner Karen Dilks asked whether, on reflection, it would have been wise to have had that conversation away from Gemma. Mr Jayakumar explained that assessments are made on a case-by-case basis whether the patient would have an understanding of what procedure they were due to undertake.

He added that reflecting on previous conversations he had had with Gemma he felt she “had the maturity to understand what we were planning to do.”

However, Gemma was “not happy” on hearing what was about to happen and the conversation continued outside the room with Gemma’s dad Graeme.

Asked whether he told Gemma “we’re going to take you to theatre and drill a hole in your skull”, Mr Jayakumar, who has since left the RVI, said “it possibly was”.

Mrs Dilks added: “Would you agree that words to that nature and description of that nature, on reflection, was inappropriate for a 12-year-old?” Mr Jayakumar agreed.

Following Mr Jayakumar’s evidence, Mrs Dilks made the following recommendation: “It’s not intended to be critical, but what I do expect if there’s some learning that arises from this.

“I do think that there should be some reflection within the neurosurgical team about communication, particularly when they are dealing with a child. A child is a child until they are 18 and it’s important to think very, very carefully about how someone who is still a child will interpret what they’re hearing and what impact that may have and the wider impact.”

Mrs Dilks asked for that message to be relayed back to the neurosurgical team.

The inquest concluded that Gemma died “due to the effects of Cerebral Venous Sinus Thrombosis (CVST)”, which prevents blood from draining out of the brain.

Ms Dilks said the underlying cause of the thrombosis was “unascertained.”

Newcastle Hospitals NHS Foundation Trust has been contacted for a comment.

Gemma Caffrey died of Cerebral Venous Sinus Thrombosis