Child death inquiry chairman questions doctors’ conflicting accounts

Banbridge Court House

Banbridge Court House

By Niall McCracken

THE chairman of the inquiry into child fluid deaths here has questioned the conflicting accounts of doctors working at the Royal Belfast Hospital for Sick Children in the aftermath of 17-month-old Lucy Crawford’s death.

Last week a number of doctors give evidence about an awareness of problems around the fluid management of toddler Lucy Crawford at the Erne Hospital before she was transferred to the children’s hospital where she died in April 2000.

At today’s hearing the chairman, Justice John O’ Hara, questioned Dr Peter Crean, consultant paediatric anaesthetist at the time of Lucy’s death, about his awareness of some of the key issues around and following Lucy’s death.

The Hyponatraemia inquiry is examining the events following the death of Lucy Crawford, as well as the deaths of four other children.

Northern Ireland’s most senior coroner, John Leckey, conducted all of the inquests into the children whose deaths are being investigated. Inquiry officials tconfirmed that Mr Leckey would be giving oral evidence to the inquiry on June 25 2013.

For more background information on why the inquiry was established please click here.

Dr Peter Crean was a consultant paediatric anaesthetist at the Royal Belfast Hospital for Sick Children (RBHSC) when Lucy was transferred there from the Erne Hospital on April 13 2000.

As reported by The Detail last week, a number of doctors working at RBHSC when Lucy was transferred also gave evidence to the inquiry – consultant paediatric anaesthetist Dr Anthony Chisakuta and Dr Caroline Stewart, specialist registrar in Paediatric Neurology.

They both spoke about an awareness of the mismanagement of Lucy’s fluids at the Erne Hospital where she was originally treated.

Giving evidence earlier today Dr Crean said initially that he was surprised to hear this evidence last week as it wasn’t something he was aware of.

Dr Crean: That does not ring true to me Mr Chairman. I was surprised when I heard this and I heard what you said on Thursday morning when I was here and I share your concerns about that.

The chairman: Dr Stewart also said that there was a general view in Paediatric Care Unit that the Erne fluid treatment of Lucy had been inappropriate.

Dr Crean: Based on what I can remember I have no memory of this taking place.

The chairman: You see the point is doctor, that they do. The two doctors gave evidence last Wednesday, who were both involved to some extent in Lucy’s treatment. Both specifically remembered there was a view within the Royal, from a fairly early stage, that Lucy’s treatment in the Erne had been inappropriate and that there was a concern about the fluids she had received. As I understand it you’re saying to me ‘I really can’t remember very much about that Thursday, It’s a long time ago and I’m looking after other children’ and I accept all that. But what I find very hard to understand is how they specifically recall that view, which they say was not personal to them and was a common view held in the children’s hospital, and how you say not only do you not remember it, but that it wouldn’t strike you on working through Lucy’s notes.

Dr Crean: What I saw in the notes was a common fluid regime that many paediatricians used at the time, but it’s not what I would have done.

Senior counsel to the inquiry Monye Anyadike-Danes QC referred directly to previous evidence from doctors when questioning Dr Crean.

Monye Anyadike-Danes QC: What Dr Chisakuta said on Wednesday is that he thought there was a questionable standard of treatment in the Erne, that’s in relation to Lucy’s fluid regime. Then he goes onto say that that he believed you had a similar concern and he would have been surprised if you had not expressed that concern at handover to him. Does that mean you disagree with that?

Dr Crean: I have no recollection of anything like that having been said. Listen, there was no reason for me to do anything like this if that’s what you’re suggesting. The following year, for example, Raychel Ferguson came in and we phoned the coroner up immediately, it was evident exactly what had happened. There was no reason not to do that. But to me it sounds absolutely preposterous where I would take a line like that and not follow it up if that’s my concern. That’s not the way I am.

Monye Anyadike-Danes QC: Nobody did very much, that’s why I’m asking these questions.

Following recess from the hearing the chairman asked Dr Crean once again if he had any concerns at all about Lucy’s treatment at the Erne.

Dr Crean acknowledged there had been issues with her notes when she arrived at RBHSC as there was no written evidence that they had actually assessed the amount of dehydration and no fluid calculations or fluid prescription on the chart.

Dr Crean: I’m not trying to defend the actions of the paediatricians in the Erne hospital. I’m not trying to say they did everything right. They made many mistakes.

Monye Anyadike-Danes QC: Dr Crean I’m simply asking with the information you had around her fluid regime would you not have a concern about her fluid regime in the Erne?

Dr Crean: I had a concern about her fluid, the way her fluids were managed in the Erne, because they were not doing in their notes what I suggested a few minutes ago.

The chairman: Sorry, doctor, when I raised this with you this morning the fact that this concern was, according to the doctors who give evidence last week, recognised fairly quickly after Lucy’s admission to the children’s hospital that her fluid regime had been identified as problematic, to put it gently you said to me that you had no recollection of this and that you were concerned to hear the evidence which they’d given on Wednesday. You have just told me that on Thursday April 2000 you did have a concern about her fluids and the way they were managed in there. Now which is it?

Dr Crean: The point I’m making is that I would have obviously had concern about the clarification of that or else I wouldn’t have made a call a doctor at the Erne. I’m not trying to defend what happened there.

The chairman: What happened in the Erne and the treatment which Lucy received is not the subject of this inquiry. What is the subject of this inquiry is if there was nothing learnt by anybody. I am told there was nothing learnt by anybody, I am told by doctors in both hospitals that there was a problem which caused her death and was recognised at the time and to put it bluntly, there are people who believe there was a cover up, and that cover up was that it involves the Royal, but also being willing to cover what happened in a completely different hospital. I’m not saying it’s a view that I hold, or the view having heard all the evidence, but by some of the families who have lost children.

Dr Crean also worked at the children’s hospital when Adam Strain died there in 1995 and previously gave evidence to the inquiry when it was addressing the governance issues surrounding Adam’s death.

The hearings continue tomorrow.