A sheriff has determined that the death of a three-year-old boy at a Glasgow hospital could have been prevented if medical staff had acted more promptly on an abnormal blood test result. Archie Donald passed away on November 20, 2019, at the Royal Hospital for Children (RHC) in Glasgow due to an infection.
Background of Archie's Condition
Archie, born on July 22, 2016, suffered from congenital nephritic syndrome (CNS), a chronic kidney condition requiring ongoing medical treatment. In 2017, he underwent the removal of his left kidney.
During a routine outpatient appointment on November 5, 2019, a blood test revealed that Archie's C-reactive protein (CRP) level was 98 mg/l, significantly above the normal range of 0-10 mg/l. CRP is a marker for inflammation and indicates infection. Despite this elevated level, Archie was not assessed for infection, nor were blood cultures taken, and he was allowed to return home.
Deterioration and Death
At his next outpatient appointment on the morning of November 19, medical staff noted that Archie appeared very pale and had developed a heart murmur. Blood tests were conducted, and he was admitted for a blood transfusion to address low haemoglobin levels, along with investigations into the heart murmur.
After being admitted to a ward that evening, Archie was monitored regularly and received further tests. Nurses administered antibiotics. However, in the early hours of November 20, his condition worsened. At 3:36 am, his mother, Caitlin Donald, pressed the emergency buzzer as Archie had stopped breathing. Despite resuscitation efforts, he suffered a heart attack and was pronounced dead at 4:36 am.
Samples taken from his intravenous line earlier that evening later tested positive for Enterococcus faecalis bacteria.
Fatal Accident Inquiry Findings
A fatal accident inquiry (FAI) into Archie's death was conducted by Sheriff Thomas Millar at Glasgow Sheriff Court. In his determination, Sheriff Millar stated that Archie's death could "realistically" have been avoided if the elevated CRP level on November 5 had been acted upon. He noted that if blood cultures had been ordered, they would "on balance" have tested positive for Enterococcus faecalis, prompting further investigations and appropriate antibiotic treatment to slow the infection's progression.
The sheriff also highlighted a failure to follow the appropriate guidelines and anticipatory care plan for Archie, which should have involved consulting an infection specialist or ordering blood cultures when infection was possible. He observed that Archie had consistently elevated CRP levels between October 8 and November 5.
Sheriff Millar added that the raised CRP level on November 5 was not documented on Archie's discharge letter, and while it would have been discussed at a subsequent multi-disciplinary team meeting, that meeting was rescheduled.
The 39-page judgment clarified that the infection's source is unknown but stressed that it was not connected to Archie's hospital visits.
Condolences and Response
Sheriff Millar expressed his condolences to Archie's family, acknowledging the difficulty of their attendance throughout the inquiry. He noted that Archie's family had cared for him diligently from birth through numerous hospital visits, and that a kidney transplant from his father was planned in the near future. The death of any child is a tragedy, but Archie's was even more so given the circumstances.
Procurator Fiscal Andy Shanks of the Crown Office and Procurator Fiscal Service stated that the death gave rise to significant public concern, prompting a discretionary FAI. He confirmed that the sheriff's determination detailed reasonable precautions that could have prevented Archie's death. The inquiry followed a thorough investigation, and the family has received a copy of the determination.
