3 days ago
23
A five-year-old girl with a rare syndrome that caused her to vomit repeatedly should have been immediately readmitted to hospital following a tonsillitis operation when she suffered a bout of sickness, a coroner has said.
The family of Amber Milnes, who had cyclical vomiting syndrome (CVS), have expressed concern that she was not kept in hospital overnight after the procedure because of her condition and say she ought to have been readmitted next morning when she began vomiting.
Amber suffered an infection and a haemorrhage and died four days after the 38-minute tonsillectomy at the Royal Cornwall Hospital in Truro.
At the end of a two-day inquest, senior coroner Andrew Cox said: “Potential complications from the triggering of a CVS episode by the operation were readily foreseeable and it may well have been prudent for Amber to have been kept in overnight. Once she started vomiting, I’m of the view she should have been immediately readmitted.”
The coroner said that Kel Anyanwu, the surgeon who carried out the operation, ought to have consulted colleagues who knew more than him about CVS.
Cox said: “I’m of the view that Mr Anyanwu should have spoken to paediatric colleagues pre-operatively, as he knew little, if anything, about CVS. This may well have impacted on decisions to discharge or readmit earlier.
“As Mr Anyanwu did not fully understand the implications of CVS, it had to follow the parents could not fully have provided informed consent. That is plainly undesirable and a point for the trust to take on board.”
However, Cox said he was not able to say that Amber’s death could have been prevented if she had been kept in hospital overnight or readmitted sooner.
Amber, from the village of St Just in Roseland, Cornwall, underwent the procedure on 5 April 2023 because she had sleep apnoea. She was discharged home within hours and began vomiting in the early morning of 6 April.
Her parents rang the hospital and were advised to wait and see how Amber did and to call back if she did not stop being sick, the inquest in Truro heard. Amber vomited about 20 times and her parents took her back to the hospital at 10pm on 6 April.
Cornwall coroner’s court heard that on 9 April, Amber suffered an infection in the area of her throat where her tonsils had been removed and a haemorrhage.
Anyanwu told the inquest he had worked at the hospital for 25 years and had never seen a death from a tonsillectomy before.
Asked about the decision to discharge Amber after the operation, he said: “The conversation was let’s see how she’s managing three, four, five hours after. The assumption was that if she was fine, she will probably be OK. The decision was made later when we saw her, that she is fine, she can go.”
Anyanwu described the operation, which took 38 minutes, as “quiet in terms of blood loss” and said he had not seen active signs of infection at the time.
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Amber’s parents, Lewis and Sereta Milnes, described their daughter as the “happiest little girl” and said she had dealt with medical treatments with courage.
They said: “Amber was and always will be our magical little princess. She was also a very brave person, and those qualities came to the fore when she first started getting poorly at the age of two.
“Once she had started vomiting, she was in and out of hospital on a regular basis, which was tough on her, tough on us all, but she took it all in her stride. Amber was so strong and when she felt sick she just got on with it.”
Outside the court, they said in a statement that it had “never for a moment crossed our minds that she might die from having her tonsils out”.
They encouraged other families to allow necessary surgery but added: “If you are worried, don’t be afraid to trust your instincts and speak up or ask questions and work with the doctors.
“Remember that no operation is risk-free, however common it may be.”
