Tragic death of autistic St Albans teenager

A ST Albans teenager, who suffered from autism, died following an apparent breakdown in communication between doctors and her parents, an inquest has ruled.

Sophie Harmsworth, 14, of New House Park, was pronounced dead at Watford General Hospital on February 12 last year.

The cause of death was given as septicaemia as a result of acute peritonitis, due to acute perforated gangrenous appendicitis.

A three-day inquest into her death, which started in July last year and was reopened on Tuesday, heard how Sophie had been unwell for six days prior to her admission into hospital. Her parents became increasingly concerned on February 8 after seeing “black bits” in Sophie’s vomit and were visited by Dr Mark Bevis at their home that afternoon.

Dr Bevis told the court during his evidence back in July that he had seen Sophie before, although not for some years, and he was aware of her autism.

Although he knew she did not like to be touched, Dr Bevis said he was able to examine Sophie and found no sign of involuntary actions which would suggest she was in pain.

A diagnosis of acute gastroenteritis was given and Mr and Mrs Harmsworth were told their daughter should improve within a few days.

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A clearly distraught Mr Harmsworth told the inquest on Tuesday that he felt Sophie was starting to get better the next day as she was playing on the Nintendo and trying to drink water.

He had made a real effort to get her to drink the following day also and she was taking in water throughout the morning. But the situation deteriorated in the afternoon and Sophie was unable to take in any more fluid.

Mr Harmsworth told how he remained with his daughter throughout the night when she indicated that she had pain in her lower abdomen.

By the morning, Sophie’s eyes had become “sunken” and her speech was indistinct, according to Mr Harmsworth, and the doctor was again called.

On arrival Dr Bevis had a conversation with Mr Harmsworth, who was confident he had conveyed to the doctor how Sophie had described pain and had not been drinking.

But Dr Bevis insisted he was sure he was not told the teenager was in pain and that she had been “drinking lots”.

There were also conflicts in the evidence about the second visit, over temperature taking, Sophie’s speech and whether she had verbally expressed pain when being moved.

Dr Bevis said he felt she had improved and advised that more fluids were given.

But her parents were still very concerned and contacted NHS Direct on the morning of February 12 following another very restless night.

She was seen by Dr Janet Jones who advised that Sophie should be taken into hospital as she was very dehydrated and might have appendicitis although she did not think the condition was life-threatening. It was decided her parents should take her in their car rather than an ambulance as the situation would have been very distressing for her.

But soon after Dr Jones left at around 9.50am, Sophie began to deteriorate very rapidly and an ambulance had to be called.

Paramedic Mark Culloty described how her blood pressure was normal but that her capillary refill suggested her body had shut down. There was a concern Sophie might have had meningitis and penicillin was administered.

He also said that she was breathing on arrival at the hospital where a full resuscitation team was waiting.

Doctors tried to revive her but she was pronounced dead at 11.36am.

A post-mortem at Great Ormond Street Hospital later revealed the main cause of death to be septicaemia and showed that her appendix was inflamed.

Dr Ashworth, who completed the post-mortem, said that gangrenous appendicitis took days, rather than hours, to develop.

Recording a narrative verdict, assistant deputy coroner Frances Cranfield said: “Sophie died on arrival at hospital after six days of fluctuating illness. There were three GP visits, with an apparent breakdown in communication at the second visit, and a rapid deterioration following the third, at which emergency admission had been arranged.”