Cork GP to be sanctioned after 10-year-old girl died from treatable Strep A infection
Cork girl Vivienne Murphy died of an invasive Group A Strep infection. Picture: Collins, Dublin.
A Cork GP is to be sanctioned for poor professional performance after a 10-year-old Cork girl suffered a painful death from an illness that is treatable if diagnosed in time.
Three findings of poor professional performance have been made against a Cork GP over her failure to recognise the urgency of the condition of the girl.
Vivienne Murphy, aged 10, from Millstreet, Co Cork died of an invasive Group A Strep infection at Children’s Health Ireland at Temple Street in Dublin on March 1, 2019 — two weeks after she had first complained of a sore throat, a high temperature, a rash, and aches and pains.
Dr Joyce Leader appeared before a fitness-to-practise inquiry of the Medical Council where she faced three allegations of poor professional performance over a phone consultation she had with Vivienne’s parents on February 19, 2019, while providing an out-of-hours clinic with SouthDoc in Kanturk.
The GP’s barrister, Rónán Dolan SC, told the hearing at the outset that Dr Leader was making full admissions to the allegations.
Counsel for the Medical Council, Neasa Bird BL, said they related to the patient’s fourth consultation with a doctor in six days when her worsening clinical condition should have been “a red flag” to the GP.
The inquiry heard that Dr Leader admitted she had failed to conduct an urgent in-person clinical examination of the schoolgirl in circumstances where she had been informed that Vivienne’s condition was deteriorating after already having had a fever for 5-6 days.
Vivienne’s parents, Lilly and Dermot Murphy, had told the GP that their daughter could not bear weight and had pains in her leg and hip.
Dr Leader was also informed by the couple that Vivienne was in too much pain to be brought by car to her surgery with SouthDoc.
The GP accepted that she had failed to refer the patient immediately to an emergency department of a hospital in order to rule out a diagnosis of septic arthritis that she had considered as a possible diagnosis.
She further admitted that she had failed to express sufficient urgency to Vivienne’s parents about the need to bring her directly to the emergency department at Cork University Hospital.
Ms Bird said the GP had left the couple as non-medical people with “the impossible task” of deciding when they should bring their daughter to hospital.
An inquest into Vivienne’s death at Dublin District Coroner’s Court in March 2023 recorded a verdict of death due to medical misadventure.
Medical records showed she had died from Group A streptococcal septicaemia with necrotising fasciitis (known colloquially as “flesh-eating disease”).
Vivienne’s parents claimed at the time that their daughter would still be alive if doctors had spotted the signs of the potentially fatal condition sooner.
Ms Bird told the fitness-to-practise inquiry that Dr Leader had also seen Vivienne in person at her clinic five days earlier on February 14, 2019, after she complained of being unwell after coming home from school.
Her condition at the clinic was recorded as “shivering, miserable with blanching rash". The inquiry heard Vivienne was screaming every time she moved her head, while her body was covered in a red rash.
Her mother said they had brought her to SouthDoc because she had a temperature of 39ÂşC and they felt it was different from a sore throat that she had suffered two weeks earlier.
Ms Bird said Dr Leader had diagnosed Vivienne as suffering a viral infection and recommended that she continue taking Nurofen and Calpol and using inhalers.
Vivienne was also seen by a different GP with SouthDoc on February 16, 2019, and by her own family doctor two days later when her parents were still concerned about her condition.
The inquiry heard both those doctors also believed she was suffering from a viral infection.
Her parents contacted SouthDoc by phone again on February 19, 2019, as Vivienne’s condition had worsened and they were unhappy with the diagnosis of the various doctors.
However, Dr Leader told them that she still believed their daughter had a viral infection, although she also considered the possibility that she had septic arthritis.
She told them that they should bring Vivienne to an emergency department if her condition deteriorated or if they were still unhappy but she did not offer to make a house call.
However, Ms Bird said the failure of the GP to stress the urgency of the situation was “starkly illustrated” by her failure to provide the family with a referral letter for CUH.
The couple, who became visibly upset at various stages during the hearing, decided themselves to bring Vivienne to CUH arriving in the early hours of February 20, 2019, as they felt there was something more seriously wrong with her.
She was diagnosed with sepsis and the inquiry heard “all hell seemed to break loose” in the emergency department after doctors received blood test results which showed she was critically ill.
Her condition deteriorated further at 7am when she went into septic shock and a decision was taken to transfer her urgently to CHI at Temple Street as there was no paediatric intensive care unit at CUH.
The inquiry heard Vivienne underwent immediate surgery later that evening to remove large areas of her lower abdomen, groin and leg.
The fitness-to-practise committee were shown “very distressing and harrowing” photos of the schoolgirl before and after the operation.
However, she suffered organ failure and went into cardiac arrest the following day. Her family were subsequently informed she had suffered irreversible brain damage and took the decision to switch off her life support on March 1, 2019.
Ms Bird said Group A Strep infection was usually a mild illness but could in more severe cases be life-threatening.
The inquiry heard a report by an expert witness, Professor Susan Smith, who found Vivienne’s condition had warranted at least an in-person assessment, a house visit or immediate referral to hospital by Dr Leader.
Prof Smith said her failure to do so represented a serious falling short of the standards expected of doctors in the management of a sick child, although she recognised that Vivienne had a condition that was “very rare and rapidly evolving".
In correspondence with the Medical Council, Dr Leader, who qualified as a GP in 2011 and has operated her own surgery since 2017, said the patient’s rash had looked viral and she had ruled out that Vivienne had meningitis or pneumonia.
The GP also admitted she was “comforted” by the fact that two other doctors had also reached the same diagnosis that the patient had a viral infection.
In their complaint to the regulatory body, Vivienne’s parents said they believed she would have survived if she had been referred to hospital earlier.
They also claimed Dr Leader was adamant that their daughter had a viral infection which could take up to 10 days to clear.
They said there was no urgency shown by the GP, despite Mr Murphy persistently seeking reassurance that Vivienne was going to be OK and she only recommended they should attend an emergency department after he had pressed her for answers.
The inquiry heard Vivienne’s parents had received an overwhelming response to calls they had made for doctors to get further education about Strep A infections to prevent deaths that could arise from misdiagnosis and failure to get early treatment for the condition.
Announcing the findings of poor professional performance, the FTP committee chairperson, Jill Long, said the fact that Vivienne could no longer bear weight was a “significant matter” to which Dr Leader should have had regard.
The inquiry was adjourned until Thursday when it will hear submissions on sanction.
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