Martha’s rule: Bereaved parents of 13-year-old who died of sepsis call for patients to be given the right to a second opinion in medical care
- Coroner ruled teen would have survived if doctors had identified warning signs
- ‘Martha’s rule’ would make it easier for worried patients to get a second opinion
Parents of a teenager who died in hospital after medics failed to escalate her care are calling for a new NHS rule to make it easier for families of patients to get a second medical opinion.
Martha Mills would have been 16 today but she died in 2021 after developing sepsis while in King’s College Hospital NHS Foundation Trust in south London.
Despite concerns from her parents about her condition at the time, medics ignored them and instead sought to ‘manage’ them.
Now her mum, Merope Mills, is calling for ‘Martha’s rule’, to give patients, families and carers the chance to easily request a second opinion from a senior doctor in the same hospital if they suspect medics aren’t taking concerns seriously.
Health Secretary Steve Barclay has announced today the Government would look into introducing ‘similar measures’ to ‘Martha’s rule’.
Martha Mills, pictured, who would have been 16 today, died after developing sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London
The teenager was being looked after at King’s after sustaining an injury to her pancreas following a bike accident while on a family holiday in Wales.
The accident pushed her pancreas against her spine causing an internal laceration to the organ.
After spending a few weeks on the ward, she developed an infection.
Martha’s condition worsened daily and she developed signs of sepsis, a life threatening overreaction to an infection where the body’s immune system starts to damage the tissue and organs.
In the UK 44,000 people die from sepsis every year.
A coroner ruled last year that the 13-year-old would most likely have survived if medics had identified the warning signs and transferred her to intensive care earlier.
WHAT IS SEPSIS?
Sepsis occurs when the body reacts to an infection by attacking its own organs and tissues.
Some 44,000 people die from sepsis every year in the UK. Worldwide, someone dies from the condition every 3.5 seconds.
Sepsis has similar symptoms to flu, gastroenteritis and a chest infection.
These include:
- Slurred speech or confusion
- Extreme shivering or muscle pain
- Passing no urine in a day
- Severe breathlessness
- It feels like you are dying
- Skin mottled or discoloured
Symptoms in children are:
- Fast breathing
- Fits or convulsions
- Mottled, bluish or pale skin
- Rashes that do not fade when pressed
- Lethargy
- Feeling abnormally cold
Under fives may be vomiting repeatedly, not feeding or not urinating for 12 hours.
Anyone can develop sepsis but it is most common in people who have recently had surgery, have a urinary catheter or have stayed in hospital for a long time.
Other at-risk people include those with weak immune systems, chemotherapy patients, pregnant women, the elderly and the very young.
Treatment varies depending on the site of the infection but involves antibiotics, IV fluids and oxygen, if necessary.
Source: UK Sepsis Trust and NHS Choices
The trust has since apologised for mistakes in Martha’s care and said in a statement that it ‘remains deeply sorry that we failed Martha when she needed us most’.
Martha’s mother, Merope Mills, an editor at the Guardian, said she and her husband, Paul Laity, raised concerns about Martha’s deteriorating health a number of times but these were not acted upon.
Ms Mills says she felt ‘ignored’ when she mentioned her concerns to a junior doctor when he misdiagnosed her daughter’s sepsis as a simple rash.
She even voiced her concern that Martha would go into septic shock over a bank holiday weekend, but this was dismissed.
Martha then died in the early hours of the following Tuesday’s morning.
Ms Mills said: ‘At King’s College Hospital, there were no consultants present after the ward round during the weekend when Martha deteriorated, and so when I had doubts about Martha’s care I had no-one senior to turn to.’
She added that nurses on the ward told her to ‘trust the doctors’.
Ms Mills said: ‘I had been “managed”, I hadn’t been listened to and I felt powerless.
‘A national expert on sepsis worked just down the corridor in paediatric ICU (intensive care): had he seen her following a review, we know her treatment would have been utterly different.
‘If a patient and family escalation system such as Martha’s rule had existed – and had been clearly advertised around the hospital with posters and stickers – I’m sure I would have used it and it could well have saved Martha’s life.’
‘When you are in hospital you are totally powerless’, Ms Mills told BBC Radio 4’s Today Programme.
‘One lesson from Martha’s deterioration is that more agency on the part of patients to challenge the culture or make hospitals safer.’
‘Asking for a second opinion when there is a deterioration shouldn’t be a problem and it shouldn’t involve confrontation.’
‘The idea of Martha’s rule it would effectively formalise the idea of asking for a second opinion from a different medic outside the team who are currently looking after you.’
Ms Mills said she thinks about her daughter every day and hope the introduction of ‘Martha’s rule’ will help other patients.
She said: ‘I hope by having these conversations we can stop other people going through this horror.’
Similar systems to the proposed ‘Martha’s rule’ already exist in some NHS trusts, such as the Royal Berkshire Hospital which has one called ‘Call 4 Concern’.
It allows patients to call a hotline for immediate help if they think a patient is deteriorating and they feel their concerns are not being recognised by the health team.
In a report with the thinktank Demos calling for ‘Martha’s rule’ Ms Mills recalls being told not to do her own research and to trust the doctors.
Martha’s mother, Merope Mills, pictured, has said she and her husband, Paul Laity, raised concerns about Martha’s deteriorating health a number of times but these were not acted upon
She said: ‘By Martha’s bedside, I was told not to look up her symptoms on the internet, to leave everything in the doctors’ hands.
‘Now, to a degree that I can never fully express, I wish I’d done more, challenged the doctors, asked for a second opinion from outside the ward.
‘For the future, I’d like to make such action easier for other patients and their carers – to make such challenges a little more acceptable and run-of-the-mill.’
Ms Mills believes ‘Martha’s rule’ would give patients and families another option if they were ‘scared and unconvinced’. That might be by allowing a patient or family member to escalate to another team over the phone to get an urgent critical care review.
Health Secretary Steve Barclay told the House of Commons today: ‘We’re exploring introducing Martha’s rule to the UK.
‘Martha’s rule would be similar to the Queensland system called ‘Ryan’s rule’ – it’s a three-step process that allows patients or their families to review a clinical review of their case from a doctor or a nurse if their condition is deteriorating or not improving as expected.
‘Ryan’s rule has saved lives in Queensland and I’ve asked my department and the NHS to look into whether similar measures could improve patient safety here in the UK.’
An NHS spokesperson said: ‘All patients and families are able to seek a second opinion if they have concerns about their care – and, as professional guidance for doctors in England sets out, it is essential that any patient’s wishes to seek a second opinion are respected.’
A spokesperson at King’s said the trust remains ‘deeply sorry that we failed Martha when she needed us most.
‘Since Martha’s death, we have put a number of improvements in place to help identify deteriorating children early, including mandatory sepsis training for all clinical staff in paediatrics.
‘We have established a new paediatric iMobile service, which involves a specially trained team reviewing any seriously unwell children on our wards, and escalating their care where necessary.
‘We also now formally document any parental concerns on our electronic paediatric early warning charts, and we have guidelines in place that recommend escalation of a child’s care in those cases where we are unable to provide sufficient reassurance to parents.
‘These are just some of the measures we have put in place, and our teams will continue to do everything they can to improve the care we provide as a result of learnings from Martha’s sad death.’
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