A LITTLE boy could have died after York Hospital staff failed to diagnose a fractured skull for 48 hours, his parents claimed today.

Stephen and Karen Fletcher said they took their six-year-old son James to the hospital - screaming in pain and vomiting - after he banged his head on concrete in a playground accident earlier this month.

They alleged that after he was admitted for observation, no one gave him a thorough head examination, an X-ray or a CT scan.

They said one doctor had explained there were strict hospital guidelines for a scan and X-ray, and James's condition did not fall in either category.

They said a nurse told them later it was thought he was suffering a tummy bug.

James was eventually discharged, but then had to return to the A & E department at York Hospital in an ambulance, following a further deterioration in his condition.

Only then, when a doctor discovered a small swelling on his head, did he have a CT scan, which revealed the fracture, a blood clot and continued bleeding.

He was rushed to Leeds General Infirmary, where he underwent surgery, to open up his skull to remove the clot and alleviate increasing blood pressure.

The Fletchers said he was now convalescing well back at their home in Bubwith, near Selby - but they claimed a consultant at Leeds had told them he could have died, had they not brought him back to hospital.

Mr Fletcher said he had written to Mr Easton to demand to know:

Why no X-ray or CT scan was given when James was first admitted - and whether the risk to his life would have been reduced if it had been?

Whether the costs of such tests was a factor in deciding whether to carry them out.

"A simple letter of apology will not be accepted," he said, stressing that he and his wife did not want a "witch-hunt", but simply improvements in standards of care so other children were not placed at risk.

"My primary objective in raising this complaint is to improve matters for the future. It is not a witch-hunt.

"My wife and I appreciate doctors and nurses have a vocation and are brave to take on their responsibilities, but this does not diminish the importance of pursuing the reasons for the procedures we experienced at York."

Mr Fletcher said the period from James's first admission until he finally underwent surgery had been "three days of hell", during which he and his wife had suffered great anxiety and James had suffered great pain.

:: Hospital chief says inquiry has been launched

Jim Easton, the chief executive of York Hospitals NHS Trust, said today that an immediate inquiry had been launched after the trust had received a formal complaint from Mr and Mrs Fletcher.

He said it would not be possible to comment further on the individual case until the investigation had been completed.

But he said that after a senior consultant paediatrician had reviewed James's hospital records on Monday morning, the trust had decided to declare the case a Serious Untoward Incident.

This meant it would be reported to the Strategic Health Authority (SHA), and the results of the investigation and subsequent recommendations would be discussed by the Clinical Risk Review Group, with the SHA monitoring the trust's implementation of the actions.

He said the complaint would still be investigated and responded to in line with the NHS complaint procedure timescales.

He added that the trust took the event very seriously and would learn lessons from it.

:: The diary of a mother's nightmare: Karen Fletcher outlines her son James's treatment after he suffered a playground head injury

Wednesday, October 12

1pm: James falls over in school playground (Bubwith County Primary), banging his head on concrete. Put in sick bay by head teacher, before returning to lessons, appearing OK. James later attends weekly swimming class. No visible signs of injury.

7.30pm-1am: James is sick five or six times and screams in pain. Husband calls emergency doctor, who advises James should be taken to hospital immediately, as it sounds like concussion.

Thursday, October 13

1.30am: James arrives at York Hospital A & E, and is sick in reception. Admitted to hospital for observation. Given Calpol (paracetamol). Not thought necessary for x-ray.

3am: Pulse, blood pressure and temperature taken. James sick again. Doctor says no reason to worry, no reason for X-ray or scan.

9.30am: James still complaining of severe headache. But doctor says all vital signs are good, no need for X-ray.

5.30 pm: After further vomiting and painful headaches, doctor says condition does not meet strict hospital guidelines for scan or X-ray. James cannot lift head and begins to adopt new posture with head face down and body slightly elevated. We become very anxious.

Friday, October 14

10am: Doctor reaffirms no need for X-ray. Says he wants to see James "up and about". I take James to canteen, against his will. He eats a few crisps, but is sick again.

1pm: I tell the nurse I am really worried something is wrong. Nurse says they think James must have stomach bug.

4pm: Husband asks for scan or X-ray and explains our anxiety. Doctor says scan or X-ray would be option three after either further observation in hospital or discharge. (Karen explains here that they are not happy with his treatment in the hospital and take him home.) Matron, who appears concerned for James, emphasises importance of calling ambulance if any further worrying signs.

9.30pm: James violently ill. Distraught and upset, husband phones for an ambulance and James is taken back to hospital. Very ill by this time and unable to keep awake.

Midnight: James seems almost unconscious and talking nonsense. Doctor closely examines James' head and feels soft swelling and arranges for CT scan. This confirms fractured skull, clot and bleeding. James "in danger", with pressure building up on brain, and has to be rushed to either Leeds or Hull for neurosurgery.

Saturday, October 15

3am: Taken to Leeds General Infirmary. Consultant apologises for what happened previously. Doctor says we have done right thing in bringing him back to hospital and this has saved his life.

6am: Surgeons open up skull to clear clot and drain blood to alleviate pressure from brain.

This is a summarised version of a diary of James's treatment at York Hospital, written by his mother, Karen.

Updated: 08:41 Friday, October 28, 2005