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THE chair of an inquiry today challenged the evidence of a succession of senior clinicians about what they discussed at a major review into hospital fluid safety as another consultant insisted that only one death had been referred to.
Mr Justice O’Hara described as “curious” the position of Dr Peter Crean whose evidence reflected that of others on the Chief Medical Officer’s working group in 2001, who have maintained that they did not raise fluid deaths they had experience of when drawing up guidelines on preventing death and injury caused by hyponatraemia – the condition of low sodium caused by excess fluid.
The O’Hara Inquiry in Banbridge has established that within the eight-member group, there several individuals had varying levels of awareness that fluid had been issue in three specific deaths – Adam Strain in 1995, Lucy Crawford in 2000 and Raychel Ferguson in 2001.
Dr Crean was also named as a consultant of a fourth child who died, Claire Roberts, although he says he had no knowledge that fluid was implicated in her death in 1996.
The true cause of Claire’s death only came to light and confirmed to her parents and the coroner in 2004 ; likewise the true cause of Lucy’s death was only made known two years after the event.
Dr Crean, a consultant paediatric anaesthetist at the Royal Belfast Hospital said he had no recollection of how he came to be invited onto the CMO’s working group in August 2001, two months after Raychel’s death.
He referred to Raychel’s case featuring in the work of the group but subsequently said he didn’t think the group were discussing cases.
Mr Justice O’Hara: Why limit it to Raychel? You’re there to try to work out an answer to a problem. Your view was that it [Raychel’s case] wasn’t on all fours with Adams. If you’re drawing up guidelines to avoid hyponatraemia only looking at Raychel’s case, it might not capture some element of Adams’s case. So … what good reason would there be not to discuss the circumstances in which other children had died apart from Raychel? Why would you not use the available information and expertise among the members of the working party to consider deaths other than Raychels?
Dr Crean: I think we were all drawing on our own expertise with children we had managed and that could include the children you mentioned.. We may not have been explicit in mentioning those names … but somewhere within us we have the management and maybe learned from that. I don’t know.
Counsel to the Inquiry Moyne Anyadike-Danes QC asked Dr Crean if it was not “the absolutely natural thing to have that discussion? Otherwise you are developing guidelines in a vacuum?”
Dr Crean said that the development of guidelines had to be based on evidence, not practice and not opinion but Mr Justice O’Hara took issue with the thinking behind such a process.
Mr Justice O’Hara: I’m just saying for the record, Doctor, I’m very curious about how the working group, who have given evidence tell me that they did not discuss the death of any child … I’m just very curious about how it comes about that a working party which is informed – of one of whose members say there were five or six deaths – draws up guidelines without referring to the deaths or without considering in its discussion those deaths.
Earlier in the hearing, Dr Crean confirmed the account of Raychel’s parents, Ray and Marie Ferguson, of how they were told very shortly after her admission to the Royal after collapsing at Altnagelvin Hospital, that her condition was almost certainly irretrievable.
Dr Crean: “I think it became pretty clear to us as the time that her collapse was so bad that brain stem death had already occurred when she arrived with us. And I think it was also clear that with a sodium level of 118, I think it was clear that that was the most likely cause of the brain swelling that had happened … the most likely cause was that while receiving IV fluids, she developed electrolyte imbalances … We didn’t investigate anything further than that at the time.
However he maintained that the doctor who took charge of Raychel’s care in Altnagelvin was right to send Raychel to the Royal to ensure all potential avenues for further treatment were exhausted.
And he denied Mr and Mrs Ferguson’s claim that he had suggested to them that Altnagelvin had been “trying to pass the buck” by sending a moribund patient to the Royal to break the bad news.
Ms Moyne Anadike Danes: Their account is very detailed …. does something suggest some sort of discussion about the quality of the management of the care at Altnagelvin. Would you have discussed this?
Dr Crean: I have no recollection of saying that and it’s not a phrase that I recognise that I would even use. …. I think we were just trying to get over the concept that she wasn’t gong to live any more.
Dr Crean was also shown a note taken within the Coroner’s office four months after Raychel’s death of a telephone conversation in which he said there had been mismanagement of Raychel at Altnagelvin: "The fluid balance was key to why her condition deteriorated.”
He maintained that while he suspected that fluid was an issue at the time of Raychel’s admission to the Royal, he could not form a firm view of this then as he did not have notes of her fluid regime.
_Dr Crean: I think that by the time I phoned the coroner, it was evident that there were errors in her management._
He was asked why this view was not reflected in his statement to the coroner.
Dr Crean: I submitted my statement to the Coroner and basically that is usually just your involvement with the child. That’s usually what you do.
The coroner’s notes of Dr Crean’s evidence also did not reflect his view that Raychel’s care had been poorly handled.
Dr Crean: The coroner will be in control of the questioning and what happens then. He did have an expert to review the care very completely and all of the things you have mentioned [issues in Raychel’s care] were laid out in that expert review of Raychel’s case. I got a copy of that beore the inquest itself, so that’s laid out there quite plainly by the expert. There was really nothing any of us could have added to that, I think.
The inquiry resumes hearings again next Tuesday.
© The Detail 2013