THE HSE HAS apologised to a young boy who developed a tracheoesophageal fistula and had to undergo multiple surgeries after doctors failed to order an x-ray which could have confirmed he swallowed a button battery.
Aaron Sikorski, from Tuam in county Galway, swallowed a button battery, commonly used in watches and other small devices, in 2018 when he was 14 months old.
Aaron’s mother, Marlena Sikorska, brought her son to their GP as well as the Emergency Department at University Hospital Galway, but an x-ray was not ordered for several days despite Marlena telling doctors she believed her son had swallowed a battery.
An alleged negligent delay in arranging investigation and removal of the battery, by both the GP in question and staff at University Hospital Galway, meant multiple opportunities to avoid the development of a tracheaoesophageal fistula were missed.
During this nine-day delay, the battery corroded Aaron’s throat, the court heard.
The medical negligence case was brought by Aaron’s mother against both the GP, Dr Maire McGarry, and the Health Service Executive (HSE).
A settlement offer of €220,000 to include the cost of future treatments and therapies has been accepted. €60,000 will be paid out in instalments every three years to pay for medical treatment and therapy, and the remaining €160,000 will be paid when Aaron (now six) turns 18.
The HSE has in the course of the proceedings admitted breach of duty (liability), but Dr McGarry denies liability.
The following apology was read out in court on behalf of both the HSE and Dr McGarry: “On behalf of the defendants, we would like to offer you our sincere apologies for the treatment that Aaron received from us in 2018.
“We regret the distress and anxiety which you and your family have experienced. We sincerely wish you and your family all the best for the future.”
Damien Higgins SC, on behalf of the family, today told the High Court that Marlena Sikorska’s concerns were ignored by doctors.
If the battery had been removed within 48 hours, long-term injury would likely have been prevented, Higgins said.
However, due to the delay in ordering an x-ray to confirm the presence of a battery in Aaron’s throat, the battery was only removed nine days after the fact.
The oesophagus – the tube that connects a person’s throat to their stomach – and the trachea – the tube connecting the throat to the windpipe and lungs – are separate.
A tracheoesophageal fistula (TOF) is an abnormal connection between these two tubes. As a result, swallowed liquids or food can be inhaled into a person’s lungs.
Aaron required surgeries to treat the TOF, and he has now been left with extensive surgical scarring, psychological trauma and residual dysmotility (a condition in which muscles of the digestive system become impaired).
His dysphagia (difficulty swallowing) has since resolved, but he is unlikely to ever be able to eat three full meals a day like other children.
Aaron will have permanent scarring, Higgins said, adding that his main scar is 14.5cm. The six-year-old will need to undergo further procedures, therapy and more surgery post-puberty, the court heard.
Aaron has displayed psychological trauma including anxiety, distress and attempts to avoid medical appointments. He is at a high risk of developing an eating disorder and will undergo treatment throughout childhood in a bid to prevent this, Higgins told the court.
Speaking after the hearing, solicitor Johan Verbruggen said the experience was "every parent's worst nightmare" and could have proved fatal if Marlena Sikorska "hadn't trusted her instincts" and insisted on an X-ray. pic.twitter.com/KhmSjpGfhI
— Órla Ryan (@orlaryan) January 17, 2024
Speaking after the hearing, Johan Verbruggen, a solicitor from Callan Tansey who represented Aaron’s family, said the experience was “every parent’s worst nightmare” and could have proved fatal if Marlena “hadn’t trusted her instincts” and insisted on an x-ray.
“Marlena told multiple doctors over three days, that she feared her one-year old boy had swallowed a battery. A simple x-ray would have confirmed that but the opportunities to arrange one were missed.
“All the while, the battery was leaking and corroding Aaron’s throat. Simply put, had Marlena been listened to, Aaron would not have suffered these horrific injuries,” Verbruggen told reporters.
Addressing the family directly in court, Mr Justice Coffey said: “I wish Aaron the very best in the future and indeed his mother and his family.”
Repeated trips to GP and hospital
On 25 July 2018, Marlena left her son Aaron on the floor, so that she could pour a cup of coffee. It was approximately 10.15am. She then heard Aaron choking and saw that he was over by the drawer. She thought this drawer had been cleared but she knew that it was ordinarily where the batteries were kept.
She immediately suspected that he had choked on a battery. She shoved her fingers down his throat to try and clearly obstruct, and he threw up. Marlena telephoned the GP practice and told the secretary that she suspected Aaron had swallowed a battery. The secretary told her to come in straight away.
When they arrived at approximately 10.30am, Marlena was frustrated to be left waiting in the waiting room while the GP saw another patient. She remembers looking at the clock and it was 11am, immediately before she was called into the GP’s room.
Marlena alleges that she told the GP that she found Aaron by the drawer choking, and she believed he may have swallowed a button battery that she recalled had been in that drawer.
The GP listened to Aaron’s chest and asked Marlena if anybody in the family had been sick recently. Marlena told the GP that her daughter had had a high temperature the weekend before. The GP concluded that Aaron could be dehydrated and advised fluids and Paracetamol.
Aaron continued to exhibit choking symptoms and breathing difficulties overnight and Marlena took an audio recording on her phone which she has retained. She brought Aaron to the GP clinic first thing the following morning, 26 July 2018. She showed the audio recording to Dr McGarry.
The court heard that the GP did not consider the need for referral or an x-ray, but noted that Aaron had had a high temperature overnight and had vomited again. His mother reported a difficulty in swallowing and mentioned her fear that he had swallowed a battery but again, no significance was attached to this, Sikorska’s legal team argued. The GP allegedly advised that it could be croup.
On 27 July 2018 Marlena took Aaron to the Emergency Department in University Hospital Galway. The nursing records document that there was a possibility of Aaron having ingested a battery, as Marlena had suggested. It was noted that he had difficulty breathing and that he was not eating.
He was seen by a registrar who noted that he also had irritability, that he had developed a temperature and coughing, and that he had bilateral air entry with no wheeze.
It is alleged that there was a failure to take a proper history and a failure to arrange a chest x-ray. The nursing records imply that the nursing staff discussed Aaron having a chest x-ray with the registrar, but that suggestion was not acted upon.
Aaron was subsequently seen by the paediatric team where, again, an inadequate history was taken, there was poor communication with the nursing team and the possibility of a swallowed foreign body was overlooked, Sikorska’s legal team said. No chest x-ray was performed.
It was alleged that if an adequate history and chest x-ray had been taken at that stage the presence of a button battery would have been identified and it could have been removed. It would not have leaked and the plaintiff would have been spared the harm he came to.
Marlena brought Aaron back to the GP on 2 August 2018 when it was noted that he had been assessed in hospital and still had difficulty breathing at night. An examination was carried out which revealed no abnormality. He was thought to have mild croup and was given more prednisolone, an inhaler and advice.
On 3 August 2018 the plaintiff returned to the GP and was referred back to the hospital. Following a review in hospital he was found to have a polyphonic wheeze.
A chest x-ray and gastrografin (dye) swallow showed a foreign body. The doctor who spoke with Marlena told her it was believed to be a coin and she said, much as she had all along, that it was a button battery.
Aaron was referred to the ENT team and taken for emergency surgery and it was indeed confirmed to have been a button battery. The foreign body was removed, but Aaron was found to have oedema around the oesophagus.
A subsequent gastrografin swallow showed a trachea-oesophageal fistula (TOF). Aaron required transfer to a specialist tertiary referral for significant and complex surgery in the children’s hospital in Crumlin in Dublin on 4 August 2018.
The paediatric surgeon came to speak to Marlena that night in Crumlin. The doctor was visibly upset, court documents note, and she told Marlena that she did not know yet what they could do to help Aaron and they would seek guidance from Great Ormond Street Hospital in London.
The surgeon placed a call and Marlena was shocked at the number of medics that entered the room. To Marlena, they all appeared upset and concerned when they were told how serious Aaron’s situation was.
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