Girl, 12, who died of a stroke after doctors refused 'persistent' requests by her mother for a scan could have survived if bleeding on the brain was diagnosed earlier, inquest told

• Victoria Olabode was admitted to Royal Manchester Children’s Hospital in 2019
• Her mother Elizabeth begged for three days for a CT scan to be carried out

A young girl who died of a stroke after doctors refused ‘persistent’ requests by her mother for a scan could have survived if bleeding on the brain was diagnosed earlier, an inquest heard.

Victoria Olabode’s mother Elizabeth spent three days begging for a CT scan to be carried out on the 12-year-old after she suffered a ‘severe’ headache and vomiting.

Victoria had been admitted to Royal Manchester Children’s Hospital on July 2, 2019, for ‘sickle crisis’, a condition where sickle cells block blood flow.

She developed the headache and sickness, and a ‘reduced state of consciousness’ on July 5 but it was not until July 8 that doctors agreed to send the youngster for a scan, which showed the haemorrhage.

Expert witness Professor Fenella Kirkham told the Manchester inquest: ‘If the diagnosis had been made between the evening of July 5 and the early hours of July 8, then I think appropriate preventative strategies as I have set out in the report would have meant that on the balance of probabilities, Victoria wouldn’t have died.’

By the time an MRI and CT scans took place on July 8 and 9, Victoria’s condition was said to be ‘irreversible’. She died at the hospital on July 12, 2019, after suffering a stroke.

Victoria Olabode, 12, had been admitted to Royal Manchester Children’s Hospital on July 2, 2019, for ‘sickle crisis’, a condition where sickle cells block blood flow

By the time an MRI and CT scans took place on July 8 and 9, Victoria’s condition was said to be ‘irreversible’. She died at the hospital on July 12, 2019, after suffering a stroke

Bosses at the hospital have already identified and accepted ‘failings’ in respect of the care she received.

When the inquest resumed on Monday, Coroner Zak Golombeck asked Consultant Haematologist Dr Sara Trompeter whether Victoria’s condition on July 5 should have ‘led to a suspicion of a neurological event’.

That day, an earlier report said Victoria was ‘screaming with pain’ and crying out, ‘Mummy, I have a headache’.

Dr Trompeter, co-author of a report with Prof Kirkham into Victoria’s care, said: ‘It would need to be ruled out.’

Victoria was seen by a doctor who ordered a ‘simple blood transfusion’ to take place with her pain medication also increased. However, Dr Trompeter said she believed an ‘urgent’ CT scan should have been ordered at that stage.

Dr Trompeter said of Victoria, who had a previous stroke in 2013: ‘The headache needs explaining, the vomiting needs explaining and she should have had a CT scan, yes.’

There were ‘further reviews’ the following day, however Victoria’s mother and father Victor were told that clinicians ‘could not see any indication for a CT scan’ and that ‘it was important she had adequate analgesia and was comfortable moving forward.’

The inquest was told there was ‘further discussion’ about a CT scan on July 7, as it was being ‘raised persistently by Victoria’s family.’

Prof Kirkham, a professor of paediatric neurology, told the inquest: ‘I think family concerns need to be taken into account as what mum was saying was that this wasn’t anything like what the family had seen before.’

A scan wasn’t carried out until the afternoon of Monday, July 8, after Victoria suffered a seizure and became unresponsive, by which point it had become an ‘extremely difficult situation’, the inquest was told. That test was followed by an MRI scan on July 8 and then a further CT scan the following day.

Prof Kirkham said that by July 9 she had fixed dilated pupils which indicated damage to her brain, which was ‘extremely serious and almost certainly irreversible.’ A post-mortem found she died of severe cerebral ischemia.

Coroner Mr Golombeck said: ‘The opinion of the experts in this case is that there were omissions in Victoria’s care.’

However, he said he would have to consider whether they ‘more than minimally contributed to her death on the balance of probabilities.’

Relatives of the youngster held a peaceful protest outside the inquest in Manchester as they called for justice for Victoria

Consultant Neuroradiologist Dr Dawn Saunders, a third expert who contributed to the report on Victoria’s death said she believed a CT or MRI scan on July 5 or 6 ‘would have shown subarachnoid haemorrhage (bleeding in the space that surrounds the brain)’.

Prof Kirkham said that if a bleed around the brain had been detected, Victoria should have undergone ‘very careful monitoring most certainly on a high-dependency unit (HDU), or on intensive care (ICU)’ and that neurosurgeons would have also likely have been consulted.

Meanwhile, an exchange transfusion – a blood transfusion in which a patient’s blood or components of it are exchanged and which eventually took place on July 9 – ‘should have been carried out much earlier than it was’ (on Tuesday, July 9), Prof Kirkham added.

However, Dr Trompeter said an earlier transfusion ‘may not have affected the outcome.’

Sophie Cartwright KC, representing the Manchester University Foundation Trust (MFT) which runs RMCH, later suggested to Prof Kirkham that ‘hindsight bias is slipping into elements of the evidence.’

Mr and Mrs Olabode, both wearing t-shirts containing a picture of their daughter, were present in court along with other members of the family. Earlier there were heated scenes as Mr Olabode shouted in court that ‘five years of our lives have been wasted.’

During legal arguments prior to the resumption of the evidence, appearing to fear a further delay to proceedings which have already had to be adjourned on several previous occasions, he told the coroner: ‘This is the last time we’re coming to this court. You have wasted our time.

‘After this, we’re going straight to the hospital and there will be continuous protest. I will not take this any longer.’ The coroner temporarily called a halt to proceedings.

Mr Golombeck said he appreciated ’emotions were running high’ but told Mr Olabode upon the resumption: ‘It’s important the dignity of this court process is respected and that I, the coroner, can continue to perform my duties in terms of investigating Victoria’s death and the behaviour that was displayed earlier will not be tolerated moving forward.’

An earlier internal report by the hospital, published in 2020, found Mrs Olabode raised ongoing concerns and requested a scan but this was ‘inappropriately dismissed’. It promised that ‘lessons would be learned’.

The inquest, expected to conclude later this week, continues.

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