Toddler's death 'could have been avoided' if doctors had tested for infection

A toddler could still be alive if doctors had ordered a blood test to be carried out, which would have alerted them to the infection that cost him his life.

Archie Donald passed away on November 20, 2019, aged just three years old.

Archie suffered from an issue that causes kidney failure, and had contracted an infection before his death.

A Fatal Accident Inquiry found that the toddler’s death could have been avoided if an abnormal blood test result had been identified and acted upon sooner.

The inquiry heard how Archie’s high CRP level had not been recognised during an outpatient appointment with doctor Heather Maxwell, now retired, on November 5.

If he had been assessed for infection and had blood taken, it was likely they would have been positive for the infection, Sheriff Millar said.

He concluded: “This, in turn, should have led to further investigations, including cardiac Echo, and a diagnosis of infective endocarditis.

“Had that diagnosis been made following November 5, then with appropriate antibiotic treatment and monitoring, Archie would not have developed the subsequent myocardial infarction and his death prevented.”

Archie had attended the children’s hospital on the day before his death for a routine appointment, where he was found to be “lethargic, breathless and had reduced appetite.”

In the early hours of the next morning, a blood test carried out showed an abnormal gallop heart rhythm, which suggested heart failure.

Archie was in distress and vomited, then suffered a cardiac arrest.

Resuscitation was unsuccessful, and Archie was pronounced dead after 4.30am.

The sheriff found defects in systems of working, including failures to follow relevant clinical guidance and Archie’s care plan, missed blood test results, and the absence of a post-clinic multidisciplinary review.

Following Archie’s death, the health board introduced an electronic sign-off system for checking blood test results, requiring consultants to tick a box acknowledging they have seen and reviewed the results.

No other recommendations were made by the sheriff.

He also ruled that, while the source of the bacterial infection was uncertain, it was not connected to Archie’s attendances at the Royal Hospital for Sick Children.

In a victim impact statement read to the FAI in 2024, Archie’s mother, Caitlin Donald, said that it was “obvious” to the family that there were numerous issues within the hospital that failed her son.

“If the infection markers in his blood tests had been acted on earlier, if tests had been done that should have been done sooner, if someone recognised that Archie actually had an infection sooner, there is a chance my son would still be alive today,” she said.

“There is never a day that I wake up and don’t think of my happy, cheeky, smart, little boy. I think about my son constantly.

“He was a bright light in not only my life but also my family’s life and everyone who got to know him.

“Knowing that Archie died from an infection that could have been treated, rather than his congenital nephrotic syndrome, makes it harder for me to understand and now need to live the rest of my life without my Arch by my side.

“I blame myself every day for not pushing the doctors to investigate his deterioration more.

“I knew something was not right with my son, but I trusted the staff and the hospital, as they had treated Archie from the age of six weeks old, when he was admitted to Ward 3C and they cared for him from then throughout his life.

“Losing Archie has totally changed my life. I have lost everything.”

Procurator Fiscal Andy Shanks for the Crown Office and Procurator Fiscal Service, Scotland’s independent deaths investigation authority, said: “The death of Archie Donald occurred in circumstances giving rise to significant public concern and as such a discretionary Fatal Accident Inquiry was instructed.

“The sheriff’s determination is detailed and notes a reasonable precaution that could have been taken to avoid Archie Donald’s death.

“The FAI followed a thorough and comprehensive investigation by the Procurator Fiscal, who ensured that the full facts and circumstances of Archie’s death were presented in evidence.

“Archie’s family have been provided with a copy of the sheriff’s determination, and our thoughts are with them at this time.”