£600,000 compensation for delayed diagnosis of cleft palate

BS was born in 2011 at a hospital managed by University Hospitals Bristol and Weston NHS Foundation Trust. Despite having a significant and obvious cleft of the soft palate, the condition was not identified at birth.

At eight weeks old, BS was reviewed by his GP due to concerns regarding increased respiratory effort. He was subsequently referred to a paediatric Rapid Access Clinic and then for an urgent ENT assessment.

At two months of age, BS was examined by an ENT paediatrician and diagnosed with laryngomalacia. However, there was a failure to carry out a full ENT examination, including an examination of BS’s soft and hard palate. It was admitted by the Defendant that this was negligent and that BS’s cleft palate should have been diagnosed at that appointment.

Over the following years, BS was seen by a range of healthcare professionals, including his GP, health visitors, therapists and specialists, but his cleft palate remained undiagnosed.

When BS was three and a half years old, he was diagnosed with a significant cleft palate and glue ear by a Consultant Paediatric and Adult Otolaryngologist. He was referred to a specialist paediatric audiologist, who advised that he required cleft palate repair and insertion of grommets. BS underwent cleft palate repair and bilateral grommet insertion.

BS’s case was that the delay in diagnosis and treatment caused, or materially contributed to, significant difficulties with his speech and language development, learning ability and executive functioning. He also experienced psychological difficulties, including a significant lack of self-confidence and social skills.

It was argued that an earlier diagnosis would have enabled BS to access timely surgical intervention and intensive support from a specialist cleft team during a critical period of early language development. BS’s case was that reduced access to receptive and expressive language during his early years resulted in linguistic deprivation, which contributed to wider cognitive, educational and psychosocial difficulties.

As a result of these challenges, BS needed increased one-to-one support to meet his special educational needs. The claim also included future losses, including a claim for loss of earnings and pension.

The Defendant disputed the extent to which the delay in diagnosis and surgery caused BS’s ongoing developmental and learning difficulties. Whilst it accepted that earlier surgery may have resulted in some improvements to his speech, the Defendant contended that there was no causal relationship between the delay in treatment and his broader developmental difficulties.

The Defendant admitted that the ENT paediatrician had negligently failed to carry out a full examination, including an examination of BS’s soft and hard palate, and that BS’s cleft palate should have been diagnosed at the early appointment. Judgment was entered on those admissions.

However, the parties remained in dispute regarding the consequences of the delayed diagnosis, including when BS would have undergone corrective surgery had the cleft been identified earlier and whether the delay had caused his ongoing educational and developmental difficulties.

The claim was resolved at an out-of-court settlement meeting, with BS receiving damages of £600,000. The settlement was subsequently approved by the High Court.

RWK Goodman acted for BS throughout his claim, obtaining expert evidence across a range of disciplines to investigate the impact that the delayed diagnosis and treatment had on his development, education and future needs.

The claim was led by Kerstin Scheel, a specialist clinical negligence solicitor at RWK Goodman. Robert Kellar KC was instructed as Counsel for BS.

A delayed diagnosis can have life-changing consequences, particularly where a child misses the opportunity to receive treatment and support during key stages of their development.

Reports into the South West cleft service have highlighted the serious impact that delays in cleft care can have on children and their families. Reviews commissioned by University Hospitals Bristol and Weston NHS Foundation Trust found that more than 100 children experienced harm because of delays to treatment, with concerns raised about the effect that missing nationally recommended treatment timeframes can have on speech, feeding, social development and emotional wellbeing.

While every case is different, BS’s claim demonstrates the importance of recognising and treating cleft conditions promptly, so that children can access specialist surgery and support at the time when it is likely to make the greatest difference to their development.

If you believe that you or your child has suffered avoidable harm because a medical condition was not diagnosed or treated in time, our specialist clinical negligence team can advise you on whether you may be able to make a claim.