The parents of a young Cork girl who died of invasive Group A Strep infection four years ago have claimed their daughter would still be alive if doctors had spotted the signs of the potentially fatal condition sooner.
Lilly and Dermot Murphy have called for a greater awareness of the dangers of the most serious form of Strep A infection among medical professionals following a verdict of medical misadventure into the death of their daughter, Vivienne, at an inquest in Dublin last week.
Vivienne (10) of Sycamore Drive, Tanyard Wood, Millstreet, Cork died at Children’s Health Ireland at Temple Street in Dublin on March 1, 2019 – just two weeks after first complaining of a sore throat, a high temperature, a rash as well as aches and pains.
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A post-mortem on the body of the girl, who was a pupil at Cloughoula National School, established she had died from Group A streptococcal septicaemia with necrotising fasciitis (known colloquially as “flesh-eating disease”).
In an emotional statement to the inquest, Ms Murphy said her family were “devastated, traumatised, shocked and overwhelmed and in disbelief” about Vivienne’s death after they were informed that it could have been avoided as Strep A is curable with an antibiotic.
“We visited doctors three times with deteriorating symptoms and nothing was done to treat our daughter,” she observed.
Ms Murphy said Vivienne’s chance of survival would have been greater if her condition was diagnosed and treatment started earlier.
“The death of Vivienne has destroyed, devastated, traumatised and ripped our family to shreds and has left a hole in all our hearts that will be with us for the rest of our lives,” said Ms Murphy.
The inquest at Dublin District Coroner’s Court heard Vivienne first felt unwell on February 14, 2019 after coming home from school.
Her mother, Lilly, described how her daughter was screaming every time she moved her head and how alarmed they were at discovering her chest covered in a red rash.
Ms Murphy claimed a doctor at SouthDoc in Kanturk who examined Vivienne, Joyce Leader, said it was only a heat rash and assured them there was nothing to worry about as it was only a viral illness and to continue taking Nurofen and Calpol and use her inhalers.
However, Ms Murphy said Vivienne’s condition remained the same over the next two days.
Dr Leader told the inquest that she believed the patient had a viral upper respiratory tract infection with a viral rash given her symptoms.
Ms Murphy recalled contacting SouthDoc again on February 16, 2019 as the rash had spread down her daughter’s thighs and all over her upper body, while she would only eat and drink when forced to do so.
She said they returned to the SouthDoc clinic later that day where another doctor, Katie Frost, gave them the same advice and to contact their own GP after the weekend if she still had the same symptoms.
The inquest heard Dr Frost also formed the impression that Vivienne had a viral illness.
Ms Murphy recounted how she had to carry her daughter in to see the family doctor, Christine Walsh-McCarthy, at the Millstreet Medical Centre on February 18, 2019 as Vivienne was unable to walk with the pain in her legs but the GP had claimed it was “just a viral rash.”
She said when her husband returned later that afternoon to the surgery with a urine sample from Vivienne that he was informed by the GP that she was sure that it was only a flu-like illness that was “going around the town.”
Dr Walsh-McCarthy told the inquest that Vivienne’s presentation was quite common in other patients at that time. As both her mother and brother, Stephen were also suffering similar symptoms, the GP said it seemed there was a viral infection circulating in the family.
Ms Murphy said her husband was dumbfounded when she informed him that Dr Walsh-McCarthy had prescribed medication for herself and Stephen but had done nothing to treat Vivienne.
When Ms Murphy contacted SouthDoc again the following day, she recalled Dr Leader said that the virus could take up to 10 days to clear.
The inquest heard there were medical notes which showed Vivienne had suffered similar symptoms a few years earlier that had been identified as Strep A for which she had been given an antibiotic.
Despite the advice of the three doctors Ms Murphy said she and her husband felt there was something more seriously wrong and brought Vivienne to the emergency department at Cork University Hospital shortly after midnight on February 20, 2019 where she was diagnosed with signs of sepsis.
While in CUH, Ms Murphy said they became particularly concerned about a black mark that had appeared on Vivienne’s leg which started spreading.
She recalled “all hell seemed to break loose” after doctors got the result of blood tests and they were informed that Vivienne was critically ill.
Ms Murphy added: “The last words we heard Vivienne say were: ‘I’m sorry for crying nurse, I know you are only trying to help me.’”
She told the coroner, Cróna Gallagher, that they beseeched doctors at CUH to operate on her and amputate her leg if it was the only way of saving her but were informed that the decision had been taken to transfer her to Dublin because there was no paediatric intensive care unit in the hospital.
“We never got to see Vivienne’s leg again until she was in Temple Street and it was cut away and lots more of her as well as our worst fears were confirmed,” said Ms Murphy.
She also expressed concern at what appeared to be a delay in transferring their daughter to Dublin.
A paediatric consultant at CUH, Susanna Felsenstein said doctors felt Vivienne would not survive surgery performed in CUH.
By the time she and the rest of her family got to Temple Street, Ms Murphy said Vivienne was out of surgery but was critical as the infection had spread.
The inquest heard she suffered a cardiac arrest the following day in a scene which Ms Murphy said resembled “a war zone with blood all over the bed and floor which will stick with us till the day we die.”
She said it was hard to believe things got worse with every passing day as they were told Vivienne needed an MRI scan to determine how much brain damage she had suffered following the cardiac arrest.
Ms Murphy said her family including Vivienne’s brother, Stephen and sister, Caroline spent the longest night and following day waiting for the results which provided “the devastating news that our beautiful little girl was totally brain dead and had no hope of recovery.”
After the decision to switch off Vivienne’s ventilator was taken, she said they would be scarred for all their lives by having “to witness our beautiful little angel gulp and gasp for 40 minutes.”
Counsel representing CUH, Temple Street and Dr Leader had urged the coroner to record a verdict of death by natural causes.
Returning a verdict of medical misadventure, Dr Gallagher, said she needed to give further consideration about recommendation and to which bodies they should be directed given the “totality of complexity” of the case.
However, the coroner said they would include increasing awareness of signs of Strep A among medical professionals and highlighted how there is no paediatric ICU in Cork together with related transport issues.
Speaking after the inquest the family’s solicitor, Rachael O’Shaughnessy of HOMS Assist, said they did not want any other family “to live the nightmare that they have been living and with which they will have to live for the rest of their lives.”
Ms O’Shaughnessy said the Murphy family welcomed the coroner’s findings but were also aware there was no assurance that Dr Gallagher’s recommendations would be implemented.
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