“This 6 year old girl presents with a years history of episodes where she complains she can’t catch her breath, her breathing becomes quite rapid, her pulse fast and her extremities very cold. These are becoming more frequent and now occur about once a week. They last for 30-60 minutes. Recently she has also looked like she's going to pass out during the episodes. Examination is entirely unremarkable. She looks well, has good colour and well perfused. Her pulse is 92 regular, heart sounds 1+2+0 and chest clear. Her parents are obviously concerned about this and I don't think we have managed to reassure them so I would welcome your advice as to whether this should be investigated further. She is otherwise well and on no medications...”
“problems: Likely vasovagal syncope... Investigations: ECG — normal. Lying blood pressure: 102/60m1 of mercury. Standing blood pressure: 109/73m1 of mercury. Plan: 1. Full blood count normal. Bone profile, urea and electrolytes normal, magnesium and liver function tests normal. 2. 24 hour ECG tape requested. 3. Discharge from clinic. It was a pleasure to review Esmee Polmear in clinic with her mother today. She has been referred to us by you with complaints of shortness of breath and heart beating fast. Mainly occurring when walking for a time, such as about 10-15 minutes wherein her face turns pale, her lips are possibly turning purple. It is reported that she develops cold clammy hands and gets very anxious at this time. These are not associated with any loss of consciousness or seizures and these symptoms are typically improved by sitting down. These episodes can last for about 15-30 minutes. There are no other associated problems. Esmee's mother reports that Esmee has a good balanced diet and good fluid intake of about 2 pints of water per day. She has normal bowel and bladder habits.... On examination today her weight was 21.5kg which on the 25th-50th centile. Her height was measured at 121cm, which is on the 50th centile. Her blood pressure was 114/75. Her respiratory examination was normal. She had normal heart sounds with split second heart sounds, no murmur heard. She had normal peripheral pulses. Her abdomen was soft and nontender. There were 170 focal neurological deficits. Plan. The plan is as suggested above, Esmee's blood were normal. A 24 hour ECG tape has been requested, I will write with the results of that in due course.”
“The 24 hour ambulatory ECG recording which was performed on Esmee from21st January 2015 through to22nd January 2015 shows that her heart rate varies normally with day to day activities and drops as expected in sleep. There were no abnormal pauses or abnormal beats. This indicates that Esmee's symptoms are more likely to be related to exertion and likely physiological with nothing to suggest an underlying abnormality of her cardiac rhythm.”
“….With Dadda, ongoing concerns re Esmee’s episodes -still c/o episodes cant catch breath, breathing, lips blue, skin pale, feels light-headed, no further syncope — but has had prey. Recently episodes ending with vomiting. Can occur home/out at school. nb seen paeds — had 24hr ecg — ok. Parents v anxious, try slow breathing/distract her but episodes occur several times a week. Would like second opinion. Otherwise well. No other concerns at school. 0/e — well, v chatty, bright, good colour, warm well perfused periph, P102, RR25, HS normal, chest clear with good ae, abdo — nad Imp — appears panic/hyperventilation. Disc re managing this, slow breathing down, can try and rebreathe in paper bag/distraction. Parents would like second paed opinion”
“I would very grateful for your further view of this 7 year old girl who has previously been seen by Dr Goyal back in February. Her parents wish for a second paediatric opinion. Over the last 12-18 months Esmee has been complaining of strange episodes where she says she cannot catch her breath and her breathing appears to be very shallow and rapid. She then goes extremely pale and after a few minutes goes quite blue around her lips. These episodes can last up to about 30 minutes and occur several times a week. They can occur at any time in the home. She has had some episodes where she has almost passed out. Over the last couple of weeks she has also complained of an episode of vomiting before the termination of the event. Between these episodes she is not had any disturbance of her bowels or vomiting. I understand that when she was seen by Dr Goyal she had a normal ECG, normal bloods and a normal 24 hour tape. Her parents are extremely worried and finding it very difficult to handle these episodes. We have discussed that these episodes do sound like she is getting anxious and hyperventilating and to continue to try with distraction and deep breathing exercises. They are finding that there is no obvious trigger to these episodes other than exertion and that they occur at any time, even when she seems quite happy and relaxed. They would like further reassurance on why they are happening and how to manage them. Esmee is otherwise fit and well. She has had a tonsillectomy and adenoidectomy in 2011... She attended with her dad today but of note in the past she has attended with her mum when seen by other colleagues and her mum has been quite tearful and very anxious. On examination today Esmee is well, very chatty and bright and had good colour. She was warm and well per fused peripherally. Pulse was 102, respiration rate 25, heart sounds normal, chest clear with good air entry and examination of her abdomen was unremarkable”
“where the defendant's negligence results in an event giving rise to injury in a primary victim, a secondary victim can claim for psychiatric injury only where it is caused by witnessing that event rather than any subsequent, discrete event which is the consequence of it, however sudden or shocking that subsequent event may be. It is true that, at [30] of his judgment (see [29] above), Lord Dyson reasons that it would be undesirable to allow recovery in a case where death had occurred months, and possibly years, after the accident. But this is a concern about delay between the accident (i.e. the event) and its later consequence. As I noted at [63] above, there is nothing to suggest that there would be any reason to deny recovery simply because the accident or event occurred months or years after the negligence which caused it.”
“On this analysis, I would hold that the Master was wrong to conclude that these claims are bound to fail on the facts pleaded. Here, unlike in Taylor v A. Novo, there was on the facts pleaded only one event: Mr P's collapse from a heart attack on26 January 2014 . On the facts pleaded, it was a sudden event, external to the secondary victims, and it led immediately or very rapidly to Mr P's death. The event would have been horrifying to any close family member who witnessed it, and especially so to children of 12 and 9. The fact that the event occurred 14 ½ months after the negligent omission which caused it does not, in and of itself, preclude liability. Nor does the fact that it was not an accident in the ordinary sense of the word, but rather an event internal to the primary victim. In a case where such an event is the first occasion on which damage is caused, and therefore the first occasion on which it can be said that the cause of action is complete, Taylor v A. Novo does not preclude liability. As I have explained, for the purposes of this strike-out application, I must assume that the present is such a case” must assume that the present is such a case”
“Taylor v A. Novo would preclude liability in the present case if there were a relevant event prior to Mr P's collapse on26 January 2014 so that the latter could be said to be separate from it. In that case, Mr P's collapse would be, like Mrs Taylor's, merely the consequence of the event caused by the defendant's negligence and not the event itself ”
“If it is necessary to identify a stopping point after which the consequences of a negligent act or omission can no longer qualify as an event giving rise to liability for psychiatric damage in a secondary victim, the most obvious candidate is the point when damage to the primary victim first becomes manifest or, as Swift J put it in Shorter (see [33] above), evident. In Walters, this was the point when the baby suffered a seizure, even though, as Swift J noted, [t]here would of course have been ongoing consequences affecting the baby's biological processes for some time previously. Had the death been a discrete event, rather than the end of a single, seamless event starting with the seizure, there could have been no liability to secondary victims for psychiatric damage caused by witnessing it. In a case where the shocking event is the point where the damage becomes evident, it is difficult to see why recovery should depend on the happenstance of whether, possibly unbeknown to the primary or secondary victims, actionable damage had previously been suffered.”
“210. In the case of Walters, it is not clear how long prior to the baby's seizure the negligence had taken place. It is, I suppose, arguable that the negligence continued from the point when the wrong diagnosis was made right up to the time of the seizure. However, in that case, the Court of Appeal made clear (paragraph 34 of Ward LJ's judgment) that the 'event' was a convenient description for 'the fact and consequence of the defendant's negligence' and that it had begun 'with the negligent infliction of damage', i.e. at the time of the baby's convulsion. That was the time when the consequence of the negligence first became evident. There would of course have been ongoing consequences affecting the baby's biological processes for some time previously but it was only at the time of the convulsion that those consequences became evident and impacted on the claimant. The Court of Appeal found that the 'event' began at that time and continued for the 36 hours up to the baby's death.”
“In Taylor v A. Novo, however, there was something that could properly be described as an event prior to that witnessed by the secondary victim the collapse of the racking boards on to Mrs Taylor (the primary victim). That event coincided with or immediately preceded the moment when actionable damage was first suffered by her, which was also the moment when that damage became manifest. The same will be true in most accident cases. But in the present case, there was nothing that could naturally be described as an event before Mr P's collapse on26 January 2014 , even on the assumption that some actionable damage was suffered before that date. The Court of Appeal in Taylor v A. Novo did not need to, and did not, decide whether a defendant could be liable to a secondary victim in such a case. It did not say, for example, that an event can qualify only if it coincides with or immediately precedes the first actionable damage to the primary victim.”