Published: 06:00, 14 January 2020
| Updated: 07:43, 14 January 2020
A heartbroken mum has told how she watched her little baby's body slowly shut down before he died of sepsis following a catalogue of hospital failures.
Five-week-old Luchii Gavrilescu was twice sent home with a common infection by medics at Margate's QEQM, despite red flags pointing to the life-threatening condition.
And on his third visit to A&E, it was almost six hours before he was seen by a consultant, by which time it was too late to save his life.
Hospital chiefs have since admitted his death was "avoidable", and a damning report reveals staff failed to recognise the severity of his symptoms and did not escalate the case to consultants, who were completely unaware of Luchii and his grave condition.
Now, his mother, Laura Cooke, has revealed the horrifying hours leading up to his death and demanded a public apology from the hospitals trust.
She tells how she twice took Luchii to A&E at the QEQM, once on November 29 after struggling to get a doctors appointment and again on December 3 after her GP voiced serious concerns over the baby's condition.
On the first visit, when he was suffering breathing difficulties and had developed a rash, he was diagnosed with a common bronchiolitis infection and sent home.
Four days later Ms Cooke took him to her GP, as Luchii was not feeding properly and his skin was mottled, and was advised to take him straight to A&E.
But again the worried mum was told it was bronchiolitis, with Luchii not seeing a consultant or undergoing any investigative tests, despite his young age and symptoms.
Three days later, Luchii died at the hospital after suffering a cardiac arrest caused by sepsis.
Ms Cooke, of Victoria Road in Margate, believes multiple mistakes were made in the care provided to Luchii, telling how she reached breaking point on the morning of his death on December 6.
The 29-year-old, who is also mum to Archie, 10, and nine-year-old Macie, called 999 at 11.16am after noticing that Luchii was floppy and struggling to breathe.
"I got him out of the car seat and he was panting like a dog; he couldn't breathe," she said.
"I knew he wasn't right."
A first responder arrived in four minutes and noted Luchii was crying - a sign she says the paramedic took as positive, so downgraded the severity of the case to call operators.
It meant a Red Cross ambulance did not arrive at the house until an hour after the first responder arrived, with Luchii not reaching the QEQM until 12.30pm.
"Even when we arrived I was sat on a chair in A&E holding Luchii, and he was till floppy and unresponsive," she recalls.
Following a review of Luchii shortly after 1pm and tests at about 1.30pm, sepsis was suspected so treatment was started.
But nursing staff and a junior paediatrician underestimated the case and failed to escalate it to a consultant.
It was only when Luchii arrived on Rainbow Ward after more than four hours waiting for a bed that a consultant recognised how ill he was.
But 20 minutes later he went into cardiac arrest and stopped breathing.
"They had to call a crash team, then went to the theatre," Ms Cooke says. "They were running through a corridor trying to put a (respiratory) tube down his throat. It was chaos.
'We need an apology from every person involved over those three visits because they all messed up' - Adam Cooke
"They were running with him in the cot telling us to 'stay back'."
Adam Cooke, Luchii's uncle, says the family were then told Luchii was stable, but they didn't get the chance to see the baby alive again.
"Laura was never asked to go to see him," he said.
"She should have been with him the whole time, but we were taken into another room. Nothing was done right.
"We need an apology from every person involved over those three visits because they all messed up."
A hospital incident report reveals a number of worrying events took place on the day of his death, including Luchii being left waiting hours in A&E for a place on a ward.
Instead, Luchii was put on a temporary bed in A&E as his mother clutched his tiny hand, willing him to get better.
According to the 72-hour serious incident document, put together by East Kent Hospitals Trust, this led to "inadequate observations" of the critically ill child.
It reveals that for a number of hours, consultants were unaware he was even there, although he had been seen by paediatric junior doctors.
Devastated Ms Cooke says she had put her trust in the medics, but believes her son was failed by every person who dealt with him.
"I just sat with him laying there in A&E, holding his hand as we waited for a bed on the children's ward and I now know that he was dying, his organs were shutting down," she said.
"This will haunt us all forever."
An investigation has been launched and, during a meeting with the family, lead investigator Dr Paul Stevens, medical director of East Kent Hospitals, admitted Luchii's death was avoidable.
The Trust's incident report says Luchii's condition was "underestimated" and should have involved paediatric and intensive care consultants at an earlier stage.
An alarming note in the report reads: "Consultant cover changed over twice but all unaware of patient."
Ms Cooke says her partner, first-time dad Vlado Gavrilescu, 29, is struggling to come to terms with losing Luchii.
"Vlado is not coping well - he can't accept it," she said.
"He can't understand how you take your child to the hospital to get looked at and you leave without him.
"Archie won't sleep in my house anymore and he's not sleeping well.
"Macie keeps crying; she doesn't understand why they went to bed and their little brother was there and they woke up in the morning to be told he's gone to heaven."
'Our investigation into Luchii’s care is ongoing and we will continue to involve his family as it progresses' - East Kent Hospitals
Ms Cooke wants a public apology from the hospitals trust and has called for staff to be retrained to recognise sepsis and for drastic improvements to be made at A&E.
An East Kent Hospitals spokesman says until the investigation has concluded they are not able to comment on Luchii’s treatment.
"Our thoughts and deepest sympathies go out to Luchii’s family, and we are extremely sorry that they have suffered such a devastating loss," she said.
"We apologise that they have concerns about Luchii’s care. We have listened carefully to those concerns and we will work as quickly as we can to be able to give them the answers they need.
"Our investigation into Luchii’s care is ongoing and we will continue to involve his family as it progresses.
"A dedicated key worker is supporting Luchii’s family and we have referred Luchii’s death to the coroner."
A South East Coast Ambulance Service spokeman said: "Our thoughts are with Ms Cooke and her family at this difficult time and we offer our sincere condolences.
"We will work with the hospital on their investigation and we are also carrying out our own investigation into the concerns raised by the family."
A friend of the family has set up a fundraising page to help with funeral costs.
To donate go to https://bit.ly/2scYqmH
What to do if you suspect sepsis
Sepsis is life threatening and can be hard to spot.
Call 999 or go to A&E if a baby or young child has any of these symptoms of sepsis:
- blue, pale or blotchy skin, lips or tongue
- a rash that does not fade when you roll a glass over it, the same as meningitis
- difficulty breathing (you may notice grunting noises or their stomach sucking under their ribcage), breathlessness or breathing very fast
- a weak, high-pitched cry that's not like their normal cry
- not responding like they normally do, or not interested in feeding or normal activities
- being sleepier than normal or difficult to wake
- in older children if they are acting confused, slurred speech or not making sense
They may not have all these symptoms.
Call 111 if:
You, your child or someone you look after:
- feels very unwell or like there's something seriously wrong
- has not had a pee all day (for adults and older children) or in the last 12 hours (for babies and young children)
- keeps vomiting and cannot keep any food or milk down
- has swelling, redness or pain around a cut or wound
- has a very high or low temperature, feels hot or cold to the touch, or is shivering