Inquiry experts fail to reach agreement

THE Inquiry into Hyponatraemia-Related Deaths resumes today with a disagreement over one piece of medical evidence still unresolved in spite of delays in the process to find common ground.

The oral hearings into the deaths of five children in hospitals in Northern Ireland is embarking on an examination of the death of the first child to die, Adam Strain, who is the subject of the dispute between a recently-procured expert, Professor Fenella Kirkham, and other medical experts who believe that hyponatraemia caused by excess fluid was the cause of his death.

It’s taken the inquiry more than seven years to move to full public hearings since its inception in 2004. It was due to start last November, but was postponed after the Belfast Trust produced documents it said had just been found about the death of Adam.

The contents of the documents prompted the inquiry to seek the views of Professor Kirkham; but when she came back with an opinion that hyponatraemia was not the cause of Adam’s death – contradicting the findings of the inquiry team and Adam’s inquest – the inquiry was postponed again to try to find common ground.

In an attempt to bring some resolution to the matter, the inquiry chairman, John O’Hara QC, arranged two lengthy meetings between the experts and senior counsel on the 22nd February and 9th March 2012. However, we can reveal that no agreement has been reached and the issue is unlikely to be resolved as the inquiry gets under way.

The repeated delays have taken a toll on the families of the children who died. In February Marie Ferguson, mother of Raychel Ferguson who died in 2001, said she had reached the end of her tether and called on Mr O’Hara to resign.

Last month at an opening hearing, counsel to the inquiry Monye Anyadike-Danes QC said the report of Professor Kirkham signaled a change to there being a “common view on dilutional hyponatraemia amongst the inquiry’s experts”.

Ms Anyadike-Danes said she would have to finish her opening statement on the first day of oral hearing on the 16th April (Monday), because Professor Kirkham’s first report was only a preliminary and the subsequent meetings between experts had produced a number of new reports that needed to be taken into consideration.

She said: “Professor Kirkham’s preliminary report and those two meetings have served to generate a considerable number of reports from the experts, as they explore and indeed challenge their differences and the bases for them.

“Reports are still coming in from the Newcastle meetings so that is actually why I am not in a position to put before you, Mr Chairman, the position of the experts on the various clinical matters relating to Adam.

“We don’t yet have Professor Kirkham’s report, her first report was only ever expressed as a preliminary, and she said that she had produced that in a rush. We await her report – and it’s a final report that will take into consideration, we hope, all the responses that she has had and the debate that has occurred in Newcastle.”

Ms Anyadike-Danes said the issues around the experts and Adam’s case was something that would have to be addressed during the oral hearings.

Expert witnesses are key figures in inquiries of a medical nature. The Inquiry into Hyponatraemia-Related Deaths has a panel of eight advisors with a mix of medical and health service backgrounds. The problems created by the inclusion of a dissenting voice – and so late in the day in this inquiry – highlights the influence they can have.

Richard Lissack, QC, an English barrister with substantial experience in this field: he represented the families of victim of the mass murderer Harold Shipman, who killed in the guise of his role as a GP; and also the parents of the babies who died in Bristol Royal Infirmary’s cardiac procedure programme.

He told The Detail: “In my experience agreement between experts is not something that is essential before an inquiry gets under way. The usual sequence is that, through the process of the inquiry, the opinions of the experts are explored in the course of all the issues being addressed. As with any investigatory system, the upshot is that the experts either do or don’t change their views and where differences remain the chairman or judge will choose which experts he or she prefers.

“But to try to shoehorn the opinion of all of your experts so that they are compelled to agree – or so that all appear to be agreed – seems a somewhat unusual way to proceed. There is no such thing as a perfect inquiry.”

The Hyponatraemia inquiry will investigate the deaths of five children who died in hospitals in Northern Ireland between 1995 and 2003. Each of the children’s intravenous fluid regime is implicated in the deaths. It is said to have caused low sodium – hyponatraemia – in four of the children, which in turn caused lethal severe brain swelling.

The children are:

Adam Strain who died in November 1995, aged four years, in the course of a kidney transplant at the Royal Belfast Hospital for Sick Children;

Claire Roberts who died in October 1996, aged nine years, at the Royal Belfast Hospital for Sick Children. At the time her death was wrongly linked to epilepsy;

Raychel Ferguson who died in June 2001, aged nine years following an appendectomy at Altnagelvin Hospital, Derry;

Conor Mitchell who died in April 2003, aged 15 years, who died following treatment at Craigavon Area Hospital. Like the other children, Conor suffered brain swelling, although his fluid regime appears to have caused hypernatraemia – excess sodium – rather than the low sodium noted in the four other cases.

Lucy Crawford who died in April 2000, aged 17 months, following treatment at the Erne Hospital, Enniskillen, for a stomach bug. Like Claire, Lucy’s death was not reported to the Coroner at the time of her death. Instead it was attributed to dehydration, rather than the fluid overload caused by the hospital;

Following the delays with Adam Strain’s case pushing it into April, it will be followed by oral evidence on Claire Robert’s case on the 11th June for a further four weeks. This change in the schedule will mean that Raychel Ferguson’s case will not be heard before the summer and will pick up again on the 3rd of September.

The oral evidence in Conor Mitchell’s case will be heard for two weeks from the 8th October with the oral evidence about the role of the Department of Health being heard for up to two weeks from the 29th October and closing submissions commencing on the 19th November.

The oral hearings will take into account both clinical and governance issues when looking at the circumstances in the lead up to their deaths. The new schedule is as follows: