Could school have saved Karan’s life?

IT IS NEARLY two years since Rina Cheema lost her only son, Karan, at the age of just 13. She had always worked so hard to protect him from his grave allergies – but the school she trusted to be equally careful was to let her, and Karan, down.

It was not the easiest of deaths, the coroner Mary Hassell heard. Karan was asthmatic and had extremely severe allergies to wheat, gluten, egg, milk and some nuts. When the cheese touched his skin, he began scratching – so fiercely that he drew blood. He panicked, pulled his shirt of, screamed and, unable to breathe, flung himself around the room – according to the coroner.

His mother is certain that, because Karan understood his allergy and how quickly he needed treatment for the reaction that was welling up, her son knew he was about to die. She told reporters that his last word were, “Please help me or I’m going to die.” Karan was taken to hospital in a critical condition and was transferred to Great Ormond Street, where he died, nearly two weeks after the incident.

There were two factors which contributed to Karan’s death: the first was that a fellow pupil knew that Karan had allergies but put a piece of cheese down his back anyway; the second was that when Karan went into the inevitable severe shock, the school’s response was “inadequate”. These are the two points which the inquest into Karan’s death, which has just concluded, looked at in detail.

Why did the boy throw the cheese?
The coroner concluded that the boy who flicked cheese at Karan was “simply not thinking”. This boy had given evidence at the inquest and told the coroner that he had not thrown the cheese in Karan’s direction for any particular reason and was just messing about. He told the inquest that he did not know that Karan was allergic to cheese.

However, a third boy who was present in school at the time gave evidence to the inquest too. He said that he had told the first boy that Karan was allergic to dairy products and had given him a bit of cheese from his baguette to throw at Karan – not knowing that cheese is a dairy product.

In his own evidence, the boy who threw the cheese admitted that he knew that Karan was allergic to wheat. He also said that he didn’t realise what serious consequences an allergic reaction could have. He thought a victim might just get a rash, or a high temperature. He apologised for what he did, saying he regretted it.

However, it came out at the inquest that the boy had previously been told off for throwing food at other children on several occasions. Karan’s mother told the Daily Mail that Karan was wearing a buttoned-up shirt and a tie and she did not understand how a small piece of cheese could have got inside his shirt. The inquest does not appear to have explored the nuances of this contradictory evidence

The boy who threw the cheese was arrested on suspicion of attempted murder just after Karan died, but no further action is being taken against him by police – although he was expelled from the school.

The school’s woeful response
The coroner said that the provision made by William Perkin school in Greenford for Karan was “inadequate”, adding that the school had missed the opportunity to educate pupils about grave allergies. She concluded that the fact that the allergy plan was not included in the school’s care plan or medical box had contributed to his death but it was not certain whether the out of date adrenalin in the EpiPen, administered in school after some delay, was a contributory factor or not.

The school’s care was “inadequate” on a number of counts.

Out of date EpiPen
A member of school staff told the inquest that the EpiPen which the school kept for Karan had expired in July 2016 and that the school had informed Karan’s mother about this in February 2017. She did not explain why the school had waited so long to tell Ms Cheema about the expiry, or why no one had chased her up about providing a new pen.

Inadequate briefing of staff about how allergic reactions occur and develop
Karan immediately told a member of staff on lunch duty what had happened. That member of staff, a science teacher named Mr Santos, gave evidence at the inquest. He said that Karan had approached him and had said that another boy had “put cheese down [my] collar” and had also said that he was allergic to cheese. This is a rather different version of the incident than the one given by the boy himself, who told the inquest that he had just flicked a small piece of cheese at Karan for no particular reason – but the apparent discrepancy was not explored in detail by the coroner.

Mr Santos told the inquest that he did not treat this as a medical emergency because Karan was not looking unwell – although he saw Karan scratching the back of his neck after the conversation ended. This suggests that Mr Santos was not aware of Karan’s “grave allergies” status or how quickly severe allergic reactions can develop. The teacher sent Karan to the welfare room to fill out an incident form, which was the procedure for low level misbehaviour. It was only there that a member of staff – a member of the school’s administrative staff who, by chance, had had training in first aid – became worried when she saw Karan’s lips and mouth swelling.

Inadequate administering of medication
he school rang Rina, Karan’s mother, to ask for permission to give him some Piriton (a drug which provides relief from the symptoms of allergic reactions such as hay fever) on the grounds that he had come into contact with something he was allergic to. They rang to ask her permission because Karan had been given Piriton before and it had made him sleepy (a common side-effect of the drug). This was a very general response, but the school should have known that Karan needed adrenalin, not Piriton.

When the school gave Karan his EpiPen, it seems that they did realise that it was out of date. They could have dealt with the emergency by taking, on an emergency basis, another pupil’s EpiPen. They did not do so because that might have deprived that other pupil of his medication. This would have been a concern – but it could have been dealt with. It should not have stopped staff from trying to save Karan’s life.

Inadequate liaison with medical staff
The school rang for an ambulance, but no one told the paramedics who responded that Karan had allergies and they treated him with a muscle relaxant used to treat severe asthma attacks. In yet another failure, the drug they used was intended for adults only: ambulance documentation has since been updated in an attempt to avoid similar errors in the future.

Inadequate control and education of pupils
The coroner pointed out that the school had not educated pupils about allergies – the substances which can cause them, and the potential consequences of an allergic response. Other evidence showed that staff were not adequately trained to cope with an allergic response taking place. It is also evident that the school did not have an adequate behaviour policy: they should have thought about the potential consequences of letting a child throw food around; they should have thought of the consequences of having a culture in which children thought it was acceptable to throw things at each other.

The school’s response to this criticism came from Dame Alice Hudson, executive headteacher of the Twyford Trust which runs four schools, including William Perkin High School. She told the BBC, “It’s my view that there was a very good general awareness of his allergies in relation to both bread and cheese.”

Medical evidence
Dr Adam Fox, a paediatric allergy consultant, gave expert evidence to the inquest, stating that incidents like this one are “very, very uncommon” – so uncommon that the doctor had never heard of any fatalities arising from skin contact with an allergen before. Dr Fox went on to stress how important it was that adrenalin is administered at the very first sign of anaphylaxis and admitted that the adrenalin given to Karan was probably not as potent as it should have been, as it was past its expiry date. This evidence suggests that the school’s poor response to the emergency was very much a contributory factor to the outcome.

The issues; the inquest
Mary Hassell, who presided at Karan Cheema’s inquest, is the coroner who last year announced a new policy of timetabling inquests strictly in order of the date of death, without taking religious issues into account – until mass protests forced her to apologise and introduce a triage system which took religious requirements into account.

Mary Hassell was the coroner at the inquest into the death of Nasar Ahmed at Bow School in 2016 too. Ismaeel Ashraf died in Birmingham, in 20 17. Both these boys suffered allergic reactions at school – in both cases, because school staff allowed them to eat food to which they were allergic. In Karan’s case, the school did not give him cheese – they just failed to prevent another pupil from touching him with cheese and then, like the other two schools, responded to the emergency in an inadequate fashion. When, and how, will schools learn the lessons of these tragedies?

Ms Hassell concluded the inquest into Karan’s death by stating that she would write up a report on what could be done to avoid future deaths. Copies would be sent to Karan’s school the emergency services, the Government and (unnamed) experts. What did she do after she concluded the inquest into Nasar Ahmed’s death two years ago? She wrote a report warning that action should be taken to avoid further such deaths in the future.

•Read more about it:
Coroner: Nasar could have been saved
Second schoolboy killed by allergy
Third boy dies from allergy at school