But expert reports, seen by The Independent, including from a liver specialist, questions the trust’s account of what happened, the quality of its post-mortem and concludes the mother-of-two – who only weighed 36kg – suffered liver failure after too much paracetamol in April 2017.
The family of a woman who died after being repeatedly overdosed with paracetamol in an NHS hospital have demanded action over her death amid allegations of an NHS cover up.
Laura Higginson, a trainee solicitor and mum of two, died after seeking medical help for sickness and pneumonia. She died two weeks later from multi-organ failure and sepsis.
Whiston Hospital, in Merseyside, has admitted to the overdose but denied it caused her death and rejects any suggestion of wrong doing.
The overdose mistake was recognised by staff on the third day but Laura’s family were never told.
The trust did not record the error as an incident and only started an investigation 14 months later when concerns were raised by Laura’s family. Her husband Antony Higginson says the subsequent investigation report is “littered with inaccuracies.”
He told The Independent: “We just want justice; we don’t care about money. Laura died needlessly and all these institutions charged with ensuring safe care and accountability have point blank failed and have rendered Laura’s life as essentially worthless and that she didn’t matter, when she did matter.”
The former soldier has spent thousands of pounds forcing the system to take a fresh look at his wife’s death. A third coroner has now opened an inquest.
The Crown Prosecution Service (CPS) has confirmed it is considering whether to bring charges of manslaughter against the St Helens and Knowsley Teaching Hospitals Trust, which runs Whiston Hospital, after a file was passed to them by Merseyside Police.
The delays in making a decision about the case have prompted Laura’s family to speak out.
Laura’s mother Denise told The Independent she wanted justice. She said: “We are being hindered at every turn, which isn’t right. It’s hard to believe that nobody seems willing to move the case on, or even to make any decisions where to go next.”
Laura’s case is not unique. The overdosing of underweight adults on NHS hospital wards was flagged by the safety watchdog, the Healthcare Safety Investigation Branch, in a report earlier this year.
There have been six incidents at the St Helen’s trust over the last four years where patients received a higher dose of paracetamol than they should have due to low body weight.
Laura had a genetic disorder, called Gitelman’s syndrome, and weighed only 36kg when she was admitted to hospital on 5 April 2017. Medical records show she was given six 1g doses of paracetamol over two days. Due to her weight she should have only been given 540mg.
The hospital has accepted Laura was given a third more paracetamol than she should have.
Blood tests seen by The Independent show Laura was in liver failure by 7 April, when a pharmacist requested a review.
Doctors discussed Laura’s condition with specialists in Birmingham who advised the injury to Laura’s liver was likely a result of a number of factors including toxic medication.
Laura deteriorated and was admitted to intensive care and treated with anti-toxicity medicine, but by then it was too late and she never recovered.
Dr Charles Millson, clinical lead for liver disease at York Hospital, told a coroner after reviewing Laura’s case in 2020: “I have to conclude that liver failure was caused by the paracetamol overdose…this lady did receive a significant excess of paracetamol and that it was this overdose that caused the liver to fail and the sepsis resulted. The sepsis overwhelmed her, and death resulted.”
He has acknowledged Laura had sepsis and existing liver problems but believes this was survivable without the liver failure caused by the paracetamol.
At no point were Laura or her husband told about the drug error and a diary kept by nurses in intensive care makes no mention of it or the antidote treatment, despite it describing lots of other treatments and reasons why Laura was in ICU.
Mr Higginson said: “I’m ex-army, I did a tour of Belfast and I thought I had seen everything, but the way Laura died was horrible. For two days solid, they were pumping her with too much IV paracetamol. It’s all there in the notes.
“Why didn’t they tell her? Why didn’t they tell us? If there was a serious risk of death we could have brought the kids in to see her. They robbed her of a legacy.”
He believes the hospital had no intention of telling Laura how sick she was adding: “When they told me that Laura was dying I had to wake up my children at 11.30pm and drive them into hospital to say goodbye to their mum. I remember Evie, being on the bed and she held Laura’s hand stroking her face. Stephen was shouting at the nurses ‘is there nothing you can do’ and he was nine.
“Nothing prepares you for that.”
Mr Higginson only learned about the overdose of paracetamol when he was given a copy of a post-mortem report by his GP months after Laura’s death.
“I replayed every minute of her death.”
When he read the report he was shocked: “When I saw what it said I knew it was wrong. I drove home and just broke down, I stayed up all night replaying every minute of her death.”
Laura’s parents had taken the couple’s children camping in Anglesey but Mr Higginson could not wait.
“I drove down to speak to them. When I got there, I passed it to Ian and I saw him turn purple in front of me. He said ‘nobody mentioned anything about paracetamol to us’.”
After buying a pack of over-the-counter paracetamol and reading the symptoms of an overdose such as jaundice and throwing up blood, Mr Higginson realised this was what happened to Laura.
“We all agreed to get the records first and see what happened – then over the next two years we reverse engineered a horror show.”
The hospital’s post-mortem report concludes Laura’s multi-organ failure was caused by micronodular cirrhosis in her liver, suggesting an underlying disease. He added: “The suggested staggered paracetamol overdose contributing to her liver injury is possible but difficult to prove with certainty.”
This post-mortem has now been criticised by a chief forensic pathologist, Professor Guy Rutty.
In a letter to the hospital, seen by The Independent, he raises the question why the autopsy was not carried out for a coroner and lists multiple mistakes including the wrong date of birth for Laura and her weight being 23kg heavier than she was.
Prof Rutty criticises “general inaccuracies” in the post mortem and discrepancies with Laura’s medical history in life. He also highlighted a failure to follow rules on samples being taken.
The trust told The Independent it had investigated Prof Rutty’s complaint with a clinical evaluation finding there were no major concerns and a referral to the General Medical Council (GMC) was not required.
Whiston Hospital says it has documented evidence that the coroner at the time was informed about the paracetamol overdose.
In July 2019, a second attempt to get an inquest by a second coroner was also rejected after doctors from the trust suggested the overdose was properly treated with an antidote and the effect was “short-lived”.
Dr Millson told the coroner in February 2020 that the antidote to the overdose was only effective if given within eight hours and Laura had received repeated doses over two days.
Concluding the overdose was what killed Laura, he added: “The time delay means that it would have been practically of little or no use at all.”
Only after Mr Higginson spent £8,000 on a legal letter challenging the coroner, was a new inquest opened. It was adjourned in July last year while the police inquiry continues.
John Doyle, principal lawyer at Slater and Gordon, representing the family said Laura’s case had raised many questions that remain unanswered.
He said: “Our own thorough investigation with leading experts will say the negligent, repeated administration and overdose of paracetamol caused Laura’s death. Whilst the trust have admitted breach of duty and causation of some injury they maintain their negligence did not cause their death. This admission and formal apology from the trust’s chief executive only came several years after Laura’s death.”
He added Laura’s family have had to wait “an inordinate amount of time for the CPS to respond due to their own due process, the Coroner will then need to re-convene before we are in a position to look to resolve the civil claim. All of this only serves to add to mental anguish, which they endure on a daily basis.”
The trust accepted there is no record of the overdose being discussed with Laura or the family and it has admitted an incident report should have been filed at the time.
It told The Independent the member of staff responsible was unable to explain why this wasn’t done.
A spokesperson for St Helens and Knowsley Teaching Hospitals Trust said: “The trust offers its sincere condolences to the family of Mrs Higginson.
“As soon as the trust was made aware that she had received a higher dose of paracetamol than that which was recommended for her low body weight, we responded openly and honestly. The trust instigated a full and thorough investigation informed by independent medical experts. This concluded that any effect of the paracetamol dose was transient and did not contribute to Mrs Higginson’s death.”
