Ryan Pitcher - The Leicestershire Epilepsy Cases

Release date: 11/9/2009

The family of Ryan Pitcher, working closely with medical negligence lawyer and deputy managing partner Robert Rose, have completed a settlement of a compensation claim against the University Hospitals of Leicester NHS Trust. The compensation claim was brought 12 years ago after their son Ryan died, following mis-diagnosis by consultant Dr Andrew Holton.

Dr Holton was a Consultant Paediatrician working at the Leicester Royal Infirmary between 1990 and 2001, with a special interest in paediatric neurology.

During his time at the Leicester Royal Infirmary, he received an increasing number of complex neurological cases.

He was suspended following concerns about diagnosis and treatment of epilepsy in children, particularly those centred on the incorrect diagnosis and inappropriate treatment.

A total of 1,948 children were diagnosed with or treated for epilepsy by Dr Holton. The Trust noted that there were concerns, or possible concerns, in approximately 1,300 cases.

Dr Holton adopted an unorthodox approach to diagnosis and treatment of childhood epilepsy.

As a result of the concerns, an independent review was launched by the British Paediatric Neurology Association (BPNA) at the request of the University Hospitals of Leicester NHS Trust. It carried out a clinical review of all patients treated, or diagnosed with epilepsy, by Dr Holton. The final report was made public in February 2003, prompting the diagnosis of epilepsy to be changed for 618 children - nearly one third of all cases reviewed.

Following the BPNA probe, there was a Department of Health review, a Trust Internal Disciplinary Review and GMC fitness-to-practice proceedings.

The Department of Health report indicated that Dr Holton had been subject to complaints nearly three years before he was suspended. The report also criticised the Trust for failing to proceed with an external review earlier than it did.

The GMC cleared Dr Holton in a private fitness-to-practice hearing, which decided that he should be placed under restrictions, but could still continue to work as long as he met certain conditions. The GMC chose to consider 12 cases. It decided he could continue working as a specialist registrar in the approved high medical training programme in neurophysiology at the West Midlands Denary, which appointed him in 2003. But he also had to face an annual performance review, ongoing assessments and agree to the appointment of a mentor for the following three years.

The BPNA found that there were 52 children’s deaths during the period that Dr Holton was practicing - but that none of those deaths were linked to the actions of Dr Holton.

In December 2008, solicitors acting on behalf of the University Hospitals of Leicester NHS Trust confirmed that, following extensive investigations, it was admitting the legal claim brought by Mr and Mrs Pitcher on behalf of their son. The basis:

• While it was reasonable to treat Ryan for epilepsy, the anticonvulsant regime that Dr Holton pursued was not in accordance with that which a reasonable body of paediatricians with a specialist interest in paediatric neurology would have pursued.
• When Ryan was admitted to hospital on 3rd November 1997, the medication regime was reviewed. The anticonvulsants were withdrawn after being deemed inappropriate and were a significant contributory factor in Ryan’s death. A personal letter from the Trust’s chief executive contained an apology which was sent to Mr and Mrs Pitcher.

The case was dealt with under the Leicestershire Epilepsy Alternative Dispute Resolution Procedure. It involved substantial investigations by both Mr and Mrs Pitchers' solicitor Robert Rose, and the solicitors acting on behalf of the Trust.

The Trust funded two reports - one from a Paediatric Hepatologist and one from a Professor of Paediatric Neuroscience.

As a result of those investigations it was found that:

• It was reasonable for Dr Holton to treat Ryan for a seizure disorder.
• There was no evidence that Dr Holton tried to define the type / types of seizure that he thought Ryan was suffering from and that he inappropriately used multiple anti-convulsants, despite being advised by two other consultants that he should either cease the anti-convulsants or just provide one. Dr Holton ignored their advice and an independent paediatric neurologist found that this impeded Ryan’s development and exacerbated his movement disorder. Crucially, it also placed Ryan at a high risk of serious and life-threatening conditions.
• The independent expert also confirmed that the use of sodium valproate in conjunction with Phenobarbitone, Phenytoin and Carbamazepine were well known to facilitate a dangerous condition known as valproate-induced hyperammonenic encephalopathy.
• That the use of Sandoglobulin and steroids was not reasonable.
• That the sodium valproate induced brain damage was indirectly responsible for Ryan’s death.

Following the admission of liability from the University Hospitals of Leicester NHS Trust, it was confirmed that the issues relating to Ryan’s treatment had been considered by the GMC's fitness-to-practice panel, but it was unable to reinvestigate the issues surrounding Dr Holton’s conduct.

BBC News On-line

Leicester Mercury