Parents of Cork girl who died from Strep A infection hope doctors will learn from failings in her care

Lilly and Dermot Murphy from Cork leaving the conclusion of a Medical Council fitness-to-practice hearing after the death of their 10-year-old daughter, Vivienne Murphy, who died on March 1, 2019, as a result of an untreated Strep-A infection. Picture Colin Keegan/Collins

The parents of a Cork schoolgirl who suffered “a horrendous death” from an invasive Group A Strep infection have expressed a fervent hope doctors will learn from the failure of a GP to recognise the urgency of their daughters’ condition, which was treatable if it had been diagnosed in time.

Vivienne Murphy, 10, from Millstreet, died at Children’s Health Ireland at Temple Street in Dublin on March 1, 2019 — eight days after her parents took the decision to rush her to Cork University Hospital after being dissatisfied with the diagnoses provided during four visits to doctors in the previous six days.

An inquiry by a fitness-to-practise committee of the Medical Council this week made findings of poor professional performance against one of the GPs, Joyce Leader, in relation to her phone consultation with Vivienne’s parents, Lilly and Dermot Murphy, on February 19, 2019, while providing an out-of-hours clinic with SouthDoc in Kanturk.

Speaking after the conclusion of a two-day inquiry on Thursday, the couple said they wanted to warn the public how untreated Strep A can be fatal and to raise awareness it is curable with antibiotics and early diagnosis.

“Vivienne was not given antibiotics early enough and the chance to live,” they said.

We are here to warn families — if you bring your child to a GP three times with deteriorating symptoms, then trust your gut and push to be seen for further investigation.

Fighting back tears at remembering how her daughter had “a radiating smile and a mischievous laugh”, Ms Murphy said they had heard their desperate phone calls to SouthDoc being played at the inquiry in which their daughter’s suffering could be heard.

“You fought so hard from your first breath of life to your last and we, your family, will fight until our last breath to make sure no family has to endure this devastating torture that has befallen this family.” 

The couple, who were accompanied by their solicitor, Robert Bourke of HOMS Assist Solicitors, said they had worked with the HSE since their daughter’s death on an information pamphlet about Strep A and sepsis.

“Nothing will bring back Vivienne, and we have had a harrowing experience that will affect our mental health forever,” said Ms Murphy.

Cork girl Vivienne Murphy died of an invasive Group A Strep infection. Picture: Collins/ Dublin

The inquiry heard Dr Leader had been informed by the couple that Vivienne was in too much pain to be brought by car to her surgery in Kanturk.

The GP accepted 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 she had considered as a possible diagnosis.

She further admitted she had failed to express sufficient urgency to Vivienne’s parents about the need to bring her directly to the emergency department at CUH.

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 and necrotising fasciitis (known colloquially as “flesh-eating disease”).

Earlier, an apology by Dr Leader to the Murphy family was read out by the GP’s barrister, Rónán Dolan, at the inquiry.

Mr Dolan said the GP wished to apologise unreservedly for her management of a 15-20-minute phone consultation with Vivienne’s parents.

“I should have emphasised the need to transfer Vivienne to hospital immediately or to call an ambulance when it became clear that it was not possible for them to bring Vivienne to Kanturk,” said Dr Leader.

The GP, who runs her own practice in Boherbue, Co Cork, said the way she practised medicine had changed since the tragic case, which had occurred early in her career.

Dr Leader said she wished to reassure the Murphy family she was now “much more aware of the risks involved in giving clinical advice” over the telephone.

In a submission to the fitness-to-practise committee, counsel for the Medical Council, Neasa Bird BL, said patient harm was a factor that should be considered in deciding what sanction should be imposed on Dr Leader after three separate findings of poor professional performance against her.

Ms Bird noted the harm in Vivienne’s case was “the most severe possible".

“It is no understatement to say that what happened Vivienne was very harrowing,” said Ms Bird.

She claimed Dr Leader’s failings had deprived the schoolgirl of a possible earlier diagnosis of a condition that had proved fatal, and which had “tormented” her parents.

She said a report by an expert witness had acknowledged Vivienne had not presented with a typical Group A Strep infection, while necrotising fasciitis was rarely seen in a primary care setting.

The report also noted the GP had provided “some safety-netting” by advising Vivienne’s parents to take her to hospital if her condition deteriorated, which Ms Bird observed was “plainly not sufficient".

However, she accepted the severity of the schoolgirl’s condition was also not immediately recognised at the emergency department at CUH.

Ms Bird noted the expert witness, Professor Susan Smith, could not state if Vivienne would have survived if Dr Leader had acted differently.

However, she said there were a number of crucial matters for the committee to consider, including that the consultation with Dr Leader on February 19, 2019, was the fourth visit to a doctor in six days, at a time when Vivienne’s condition had not improved.

Ms Bird said a significant development had been Vivienne’s inability to bear any weight and pains in the joint of her right leg.

She said the potential diagnosis made by Dr Leader that the patient might have septic arthritis should also have led to a physical examination of the patient, which could have allowed an earlier diagnosis of the necrotising fasciitis.

Ms Bird said the GP had enough information to act when an immediate referral for an urgent examination “should have been the only clear and unambiguous advice".

It was also something “available and easily done”. She observed Dr Leader had not provided the patient with any referral note to go to hospital.

Ms Bird called for the GP to be censured “at a minimum”, as well as recommending conditions should be attached to her registration which should require her to undergo further education in relation to Strep A and sepsis, as well as her specific failings.

In a plea of mitigation, Mr Dolan said Dr Leader had made full admissions and had shown “contrition and insight”. He said the GP had made her diagnosis of Vivienne’s condition in good faith in what was acknowledged as “a rare and rapidly evolving clinical condition”. 

Mr Dolan said the case had had a profound impact on Dr Leader’s practice and her vigilance, and she had already voluntarily participated in courses relating to Strep A and sepsis and would continue to do so.

He suggested the GP could be admonished, but accepted that the case “may warrant censure".

At the conclusion of the hearing, the inquiry chairperson, Jill Long, said the fitness-to-practise committee would forward its recommendation on sanction to the Medical Council.

Any ruling on sanction has to be determined by the full Medical Council, with more severe sanctions needing to be ratified by the High Court.