Lad, 4, dies two hours after being sent home by doctor

A four-year-old boy died just two hours after being sent home by a GP, an inquest has heard. George Thomas Spencer had an underlying condition which caused his heart to suddenly stop.

George was described as a “cheeky and happy” little boy. He had a history of contracting croup, the viral infection.

He died on March 19, 2021. Staff at his school, St James Primary, had noticed his breathing was “raspy”. When mum Danielle collected him from after-school club and saw that he was having difficulty breathing, his dad Terry took him to the GP.

An inquest at Accrington Town Hall today (June 13) heard that Dr Jill Osgood examined George at Clitheroe Health Center on March 19 last year. She told the hearing that she was experienced with patients suffering from croup, which could be “variable in its presentation”, LancsLive reports.

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Dr Osgood told the inquest after examining the youngster, she found that his heart rate, temperature and oxygen saturation were all “within the normal parameters”. She added: “He was very chatty and joking, speaking in full sentences, there was no hoarse voice, but I did hear noisy breathing.”

George, who has an identical twin called Arthur, was taken back home, but later that evening his parents noted a deterioration in his condition. At around 7.15pm they noted his lips were blue and called an ambulance. A neighbour, a qualified first responder who had trained paramedics in using defibrillators, used a nearby machine to issue a shock to George’s heart.

Paramedics then arrived at their home in Clitheroe, Lancashire, and carried out resuscitation attempts for some time before arriving at the Royal Blackburn Hospital at around 8.30pm. Paediatric consultant Dr Peter Fitzmaurice said he was called at 7.30pm ahead of George being brought in.

“The paramedics didn’t arrive for about an hour, so everything was getting a bit ‘what’s happened here?’ because normally they just get them to hospital,” Dr Fitzmaurice said. “Then it came through that they were having to resuscitate him at home, which was why it was taking so long.

“George, who was born in Burnley in 2016, arrived at about 8.30pm, but after continued cardiac compressions there had been no output. Resuscitation was very unlikely to have been successful. George was brought in, we did a quick assessment and I went to speak to parents to say there was no signs of life.”

A post mortem revealed the cause of death was myocarditis – a “notoriously difficult disease to diagnose”, Dr Fitzmaurice said, which can develop after a viral infection and causes inflammation of the heart muscle. The inquest heard that, even if George had been sent to hospital from the GP surgery, he would likely not have been given an ECG which would have detected the myocarditis.

“From what mum and dad told me about George that day, he was running round he wasn’t showing any signs of the heart failing in the build-up or two weeks before so there were no signs that George’s heart was compromised,” Dr Fitzmaurice said. “If you come into hospital it would still have been difficult to diagnose especially if there was croup beside it. We would have managed the croup because that was staring you in the face and we would have brought the tachycardia [fast heart rate] down.

“With croup you’re not supposed to upset the child too much. It’s one of the hardest things to diagnose in paediatrics. So it would depend on the level of tachycardia and at 130 we wouldn’t be doing an ECG on a child. “

The inquest heard that myocarditis can be caused by an infection and George had been ‘susceptible to croup’. “George’s heart had some inflammation on it from an infection at some stage, which meant that it was susceptible to not functioning properly and that can present in different ways, and can suddenly stop by itself or it could have stopped if something had acted as a trigger,” Dr. Fitzmaurice said.

“The heart rhythm was abnormal before it stopped and that’s unusual in children. Where does the croup come into it and was it an attributable factor? It’s not easy to say. What would have happened with the croup with the heart being in the condition it was in.”

Area Coroner Richard Taylor asked Dr Fitzmaurice if the croup had contributed to George’s death. The consultant said it was “impossible to say with certainty” but said: “I think that the croup did contribute to the irregular heartbeat, but I can’t say that 100 per cent. But the myocarditis could have proved fatal without the croup. “

George’s parents, who attended the inquest, asked Dr Fitzmaurice if steroids prescribed by the GP would have prevented his death. “It may have resolved the croup, which may have taken the stress off the heart, but the myocarditis could have progressed and three weeks later he could have been in hospital,” the consultant replied.

Ultimately, Dr Fitzmaurice agreed that the croup “could have been irrelevant” and that the myocarditis could have proved fatal on its own. “He could have had a cardiac arrest that night without the croup,” he added.

Pathologist Dr Jo McPartland from Alder Hey Hospital, who concluded the medical cause of George’s death was myocarditis, said his heart was “significantly enlarged”. “It was around the size of a heart expected for a nine-year-old child and the ventricles were larger than normal.

“Under the microscope there were areas of inflammation. There were also areas where the heart muscle cells had died.” Even allowing for George’s bigger than average size his heart was around 50g heavier than it should have been.

“It’s a rare condition, but I have seen a few cases of sudden, unexpected death in children from myocarditis. One child was admitted to hospital, thought to have pneumonia, but then died and another died in their sleep. We often don’t know it’s there until we do a post mortem and examine the heart tissue.”

George also had inflammation in his voice box, although Dr McPartland “didn’t think there was a critical narrowing of the airways”. Despite this, she concluded the croup was a contributory factor in George’s death, as it can cause an irregular heart rhythm which can result in cardiac arrest, although she did also find three other viruses present in his system which could have caused the myocarditis.

Returning to a narrative conclusion, the coroner said: “The 19th of March last year should have been a normal day. George was at school, all appeared to be fine until half an hour before he was being collected. He had a rasping sound in his voice and that was reported to his mother who collected him.

“Her immediate reaction was croup, she believed he needed steroids, why? Because she knew that from previous episodes. An appointment was arranged with the GP at 5pm. She anticipated this was likely to be croup.

“She did see him face-to-face, but the doctor believed, from the tests and examination, that this was more likely than not to be a respiratory tract infection and George was sent home with an inhaler. Within an hour and a half or so George had stopped breathing and despite the best efforts of neighbors and paramedics he was taken to hospital, where he was sadly pronounced dead.

“The family have concerns; why was he not given steroids or sent to hospital? Dr Osgood said the tests did not indicate croup and it was only at the post mortem that the true picture was revealed. Not only was there croup but also inflammation of the heart muscle, which was likely to have been present for some time.

“George Thomas Spencer died on March 19, 2021, from an inflammation of his heart to which more likely than not a contributory factor was an undiagnosed viral infection.”

After George’s death his family and friends raised more than £8,400 to install defibrillators around Clitheroe as well as a memorial bench at the nearby beauty spot of Edisford Bridge, where the family enjoyed spending time.

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