The introduction of Martha’s Rule has come into effect following the preventable death of 13 year old Martha Mills in 2021 after a fall from her bike developed into life threatening sepsis which was not treated in time.

Giving patients and their families the right to an urgent second opinion in circumstances when their concerns about sepsis are ignored by medical staff, medical negligence expert Diane Rostron believes the new scheme will empower families in a desperate situation.

More lives could be saved by implementing Martha’s Rule

Sepsis is a life threatening, but easily treated condition – when the symptoms are picked up and antibiotics are provided in a timely manner.

The introduction of Martha’s Rule is a positive step to giving more weight to families with serious concerns about a patient’s condition.

The team at Diane Rostron have sadly represented a number of families that have found themselves in a critical situation with a visibly unwell loved one and their concerns about sepsis either ignored or dismissed until it is too late.

Martha’s Rule sadly comes too late for them however, the new scheme ensures that sepsis is a critical patient safety priority.

Safety of patients could be increased by implementing Martha’s Rule

Evie Crandle was 15 months old when her parents took her to Whiston Hospital, in Merseyside, in April 2018 with a high fever of 39.8C. She had been refusing to eat her breakfast and had been vomiting.

Her lips were alternating in colour between pink and blue and she was lethargic. Her parents Sam and Phil were very aware of the red flag symptoms of sepsis and had repeatedly tried to alert medical staff.

Their valid observations were dismissed despite their consistent requests that their first born daughter be tested for sepsis and given antibiotics.

If Martha’s Rule had been in effect at the time, Evie’s parents would have had the right to ask for a second medical opinion at the same hospital.

Missed opportunity to ensure patient safety

Evie was discharged later the same day and only given ibuprofen and Calpol despite several tests and symptoms indicating sepsis. Evie’s parents brought her back to the hospital again within two hours because they were so concerned.

She was only then given IV fluids more than 15 hours following her first admission when her condition had significantly deteriorated.

She died two days later at Alder Hey Children’s Hospital where she had been transferred following an admission into intensive care.

An inquest found that Evie’s death was preventable. It is sad that Martha’s Rule has come too late for Martha Mills, Evie Crandle and other patients whose deaths could have been avoided.

The new scheme will empower families to have their concerns heard and for medical staff to ensure that they not only take patients’ sepsis concerns seriously, but to correctly follow the national guidelines – including nationwide usage of sepsis screening tools.

Patients and families supported with Martha’s Rule

Martha’s Rule means that a patient, their family or carer are now entitled to ask for an urgent second medical opinion if their sepsis concerns are not being acted on.

Diagnosing and treating sepsis with antibiotics in a timely manner when a patient’s condition has deteriorated, and may be in intensive care, can save lives.

It provides vital reassurance to families following Martha’s death when an accidental fall or illness turns into an infection that overwhelms the body.

When families can implement Martha’s Rule

Sepsis can occur when the body becomes overwhelmed by an infection caused by an illness or an accident.

It is easily treated with antibiotics but is life threatening if not diagnosed and critical care provided on time.

If a patient is showing signs of sepsis and the medical team are not listening or responding to concerns and requests for a diagnosis and antibiotics, Martha’s Rule can be implemented and an urgent second opinion provided.

Knowing the sepsis red flags and when patients and their families can exercise Martha’s Rule

Some of the red flag symptoms of sepsis listed by the NHS include:

• Blue, grey, pale or blotchy skin, lips or tongue
• A rash that does not fade when a glass is rolled over it – similar to meningitis
• Difficulty breathing
• Lethargy
• Confusion, slurred speech or the patient not making any sense

One red or amber flag on many screening tools is a sign that something is not right – it is sometimes ignored as a valid red or amber flag, with other criteria often given more weight such as a patient’s temperature.

It is hoped that Martha’s Rule will give this flag on the pathways the weight it deserves. 

It is essential that these signs are picked up swiftly and a sepsis diagnosis and treatment given quickly to save lives.

In some instances, it may be appropriate to provide antibiotics when there are worrying signs before a formal diagnosis can be provided in the interests of timely care.

Martha’s Rule gives a voice to patients and their families

Martha Mills died as a result of a treatable infection following a fall off her bike. The government has backed plans to introduce Martha’s Rule which came into effect in April 2024 as a result of her avoidable death.

Whether the new scheme is successful will depend on whether families use Martha’ Rule to exercise their rights and whether the medical staff implement an urgent second opinion which could save lives.

Instructing a solicitor if Martha’s Rule is not followed

If a patient dies as a result of sepsis that is not diagnosed or treated in time, and Martha’s Rule was not implemented by medical staff, the affected family can make a claim for compensation.

A medical negligence claim would have to prove that the patient’s death could have been avoided if the appropriate medical care had been given.

The compensation considers the pain and suffering caused to the family as a result and financial losses if the patient leaves dependents behind.