The public inquiry into Hyponatraemia-related Deaths was announced in 2004
THE mother of a child who died after being overloaded with hospital fluid today (Tuesday) called for doctors and nurses who have lied at the inquiry into her death to be charged with perjury.
Marie Ferguson issued the call after she and her husband Ray provided a harrowing testimony about the final hours of their nine year-old daughter, Raychel, at Altnagelvin Hospital and Royal Belfast Hospital for Sick Children in June 2001.
In a statement read into the record of the hearing, she also challenged the refusal of the Directorate of Legal Services – the health service’s legal unit – to admit liability for the death of Raychel more than 12 years on, a position she said was driven by cover-up.
“The past 12 years have been horrific,” she said. “We have never come to terms with the needless death of Raychel as we have spent 12 years fighting instead of grieving and this is why we feel our opinion has to be heard.”
The Inquiry into Hyponatraemia-related Deaths was set up eight years ago to investigate the deaths of Raychel and other children who were killed by the maladministration of intravenous fluids in hospitals in Northern Ireland or where fluids were implicated in the deaths.
Its substantive oral hearings have been taking place in Banbridge courthouse since February last year about the deaths of Adam Strain (4) 1995 and Claire Roberts (9) in 1996, both in the Royal as well as that of Raychel. Future hearings will explore aspects of the deaths of Lucy Crawford, who was 17 months old when she died after treatment at the Erne Hospital in Enniskillen, and of Conor Mitchell, who was 15 when he died following treatment in Craigavon Area Hospital.
Mrs Ferguson said that, having read Raychel’s full inquest file last week, it was “so obvious that the trust were involved in a cover up” and she added: “And now they have the help of their lawyers, the DLS.”
She excluded counsel currently acting for the DLS, Michael Stitt and Michael Lavery from her criticisms, as well as the solicitor currently instructing them at the hearings.
However, she said she believed that a number of people, nurses especially, had lied under oath “even here” and she said: “The police should be called in again and they should be charged with perjury.
“They have told barefaced lies and that is so obvious now, I think the police should be looking at these cases again, but especially the evidence given by nurses and doctors and if any of them can be charged with perjury, then they should be.”
She continued: “After all that we have heard about Raychel’s case and all that we knew beforehand, the fact that the DLS maintain a denial of liability on behalf of the trust, it is totally unbelievable.
“No legal or technical excuse for this will do. It is simply appalling, but in our view it is driven by the cover-up that the DLS are central and involved in in relation to Raychel’s death.
“I know that litigation is outside the inquiry, but can anyone imagine what it is like for us to sit here and again in view of what we’ve heard when the DLS on behalf of the trust deny liability for Raychel’s death? It is very upsetting, it adds to all the pain and suffering that we have already endured over the last 12 years and will for the rest of our lives."
Raychel, Adam, Lucy and Claire all developed hyponatraemia – the medical term for low sodium – after their natural levels of sodium were diluted by excess levels of intravenous fluid administered by the hospitals.
The hyponatraemia made their bodies susceptible to swelling and the continued use of the fluid – itself the cause of the hyponatraemia – then caused internal organs to swell quickly and to lethal effect; in all four cases their brains swoll to the extent that it became crushed inside the skull, leading to fitting and then death.
In each case the use of a fluid known as Solution 18 – which is far more dilute than standard saline fluid – was implicated.
Raychel’s death was the subject of an inquest, which was called shortly after her death. However Mrs Ferguson said she had always been convinced that Raychel’s death had been the subject of a cover up and that there had been more deaths which had not come to light. What she has witnessed at the inquiry had further confirmed that, she indicated.
“Having had so many meetings with our solicitor, e-mails, telephone calls, we have heard so much of how it might have been that all of the children involved in the inquiry and especially Raychel may have had some peculiar reaction to Solution No. 18 as Solution No. 18 was used safely before. But how do we know that? Where is the evidence for that from the trust?
“I don’t trust the trust or believe a word they say. I don’t want to cause a major problem for the Inquiry, but I am concerned more children and even adults may have died from hyponatraemia, but the trust has covered the deaths up and families have been lied to.
“I’m even more convinced of this now with all the evidence that I’ve heard recently. You would think we were talking about the Stone Age.
“My daughter died in the 21st century, 12 years ago. It seems like yesterday to us. But this constant talk of standards at the time is absolutely no excuse for Altnagelvin killing our daughter.”
Solution 18 was withdrawn from general use following the death of Raychel and the publicity which surrounded it – largely driven by persistence of her parents’ campaigning in the media.
Mrs Ferguson said: “It should not have taken the death of our daughter for a change in procedure to come about.
“I believe that the Department of Health knew full well about the deaths of Adam Strain, Claire Roberts and Lucy Crawford before Raychel’s death. Some of the experts and witnesses talk about their early days, it wasn’t that long ago, but not for us anyway.”
She also drew attention to the deaths which had preceded Raychel’s and the failure for lessons to be learned from them; both Lucy’s and Claire’s deaths only came to the attention of the coroner after Raychel’s and the real reason for them, acknowledged in an inquest.
Before Raychel’s death, however, the then Sperrin Lakeland Trust commissioned a report into Lucy’s death from a consultant at Altnagelvin, Dr Murray Quinn, whose report reflected the low level of sodium in Lucy’s system, but did not recognise this as the cause of her death.
Mrs Ferguson said: “What did Altnagelvin and the trust know about the Lucy Crawford case? One of their own doctors, Dr Murray Quinn, carried out a discredited report on Lucy’s death.
“Putting aside what is in Dr Murray Quinn’s report I just find it hard to believe that not one person, even medical or administration, didn’t know about Lucy Crawford’s avoidable death at Altnagelvin. But I will wait to hear the evidence on that.”
During their testimony, Mr and Mrs Ferguson set out the sequence of events which led up to Raychel’s death, starting with her returning from school on the afternoon of June 7 where she was her usual exuberant self and excited after winning a medal that day in the school sports day.
She later complained of stomach pain and, when her colour changed she was taken to Altnagelvin where she later underwent surgery to remove her appendix – which her family now believe was unnecessary.
The following morning she was described as bright, talkative, painfree and showing good signs of recovery including getting up out of bed and walking down the corridor with her father.
However she started to vomit – subsequent enquiries have linked this to her fluid regime – and this continued all morning, all afternoon and into the evening until about 11pm that night.
Mr and Mrs Ferguson described Raychel returning to bed around noon because of the nausea, becoming increasingly listless and then “like a zombie”, barely acknowledging anything or anyone around her.
They described repeatedly bringing each instance of sickness to the attention of nurses on duty and every time Raychel’s persistent nausea being shrugged off as “normal, natural after an operation” – even when she was exhibiting signs of vomiting blood.
Mr Ferguson said: “We were concerned but we through she was in a safe place … they knew best.”
Mrs Ferguson said: “She was always being sick; she’d been sick all day; and it was the way she was being sick – really straining.”
She also said the attitude of the nurses was “cheeky” and said: “They thought that we were fussy and that was it.
“I knew Raychel was unwell but they weren’t listening to what we were saying.
“They didn’t have any concern; they thought she’d had an appendix; she’ll be OK.”
Raychel stopped being sick at 11pm that evening and appeared to be asleep and Mr and Mrs Ferguson left for home at 12.40am on the advice of staff.
At 3am, a phone call to the family home advised them to return to the hospital as Raychel was having a fit.
Mr Ferguson went ahead of his wife and arrived at the hospital at 3.45am to a scene he described as “chaos” with people working with Raychel.
When Mrs Ferguson arrived shortly after, she found her husband in a side room in tears, having been told Raychel was “seriously ill”, however both Raychel’s parents were adamant that the scale of what had happened to Raychel was kept from them.
The inquiry has already heard that the medical notes recorded that by 5am Raychel’s pupils were fixed and dilated – a classic indication that death has occurred – however the Fergusons described how from the moment they arrived in the hospital, they were consistently given updates which sounded promising.
A consultant – the first to deal with Raychel since her admission to hospital – only told them that they needed to get her sodium up.
The Fergusons described another health professional – who they named but who the Trust has yet to confirm the identity of – telling them that she was to be taken to Belfast for an operation with her prognosis becoming clear within a couple of weeks. The trust denies that the family was ever told that Raychel was to have further surgery in Belfast.
The Fergusons also said they went to see Raychel after she’d been taken to the Intenstive Care Unit to find a priest anointing her.
Mrs Ferguson said: “I couldn’t understand that because I understood that if you’re given the Last Rites, you’re going to die and Raychel wasn’t dying.”
Mr Ferguson said: “I have a vague memory one of the nurses said: ‘It’s routine to have a priest’.”
Mrs Ferguson later said: I remember a wee nurse coming up when she put her hand on my knee and she said that she was so sorry and I remember saying to my sister: ‘She’s going on as if Raychel’s dead’.”
Early in the morning of the 9th, Altnagelvin’s clinical director, Geoff Nesbitt, arrived and confirmed that Raychel was to be taken to the Royal later that morning, accompanied in the ambulance by him; her parents were to follow in the car.
On their arrival in Belfast, they encountered Mr Nesbitt, who, Mr Ferguson said, told them that Raychel had had a good journey and that there had been “plenty of movement”, which was a good sign. This continued to give them hope.
The inquiry has already heard from another doctor that no medical professional could possibly confuse the meaning of movement in a child in Raychel’s condition because they would understand that it would be reflexes involving the spinal cord and not normal movement.
Mr Stitt, for the trust, suggested that the Fergusons had misunderstood Dr Nesbitt’s comments, which he had not intended to suggest that there was hope.
Mr Ferguson insisted: Our recollection is Dr Nesbitt, just before he got into the ambulance [to return to Derry], said she had a comfortable journey coming up, a lot of movement or movement and that’s a good sign. That gave us hope. That’s what I’d like to say. That gave us hope when we heard that.”
Inside the Royal, doctors told the Fergusons that Raychel’s condition was critical and it was made clear to her that the situation was hopeless.
Later, in their statement to the inquiry, Mrs Ferguson stated: We feel we should have been told the truth at the earliest opportunity, which we now know was 5 o’clock in the morning on 9 June.
“Listening to all the evidence here at the inquiry’s, Raychel’s eyes were fixed and dilated at 5 o’clock. The doctors knew then there was no going back.
“We did not leave Altnagelvin until 11 o’clock. That was six hours later. All we were given was false hope in that Raychel would get an operation and that she would remain in the Royal for two to three weeks.
“In our view, we believe the cover-up began on the morning Raychel was being transferred to the Royal, we now know the situation was hopeless.”
In the family statement, Mrs Ferguson described Raychel as the daughter the family had longed for – Raychel had three brothers; “happy, caring, not a worry in the world and very bright”.
“She loved animals so much. She said when she grows up that she was going to be a vet and if she had load of money she would give it to the poor.
“No one here would understand in the aftermath of Raychel’s death I had to spend consoling her three brothers … we as a family went to the grave at 8 o’clock every night, hail, rain or snow and stayed until 9 because that was bedtime.
“My three sons have suffered tremendously. Not only did they lose a sister but they lost out on a mother, a normal childhood, something as simple as going to a park or McDonald’s didn’t happen because of the guilt I was feeling and how could we enjoy ourselves with Raychel lying in a cemetery.”
She added later: “I made Raychel a promise the day her coffin was closed and she left home for the last time that I would not stop until I got to the truth of what happened of what robbed me of the most precious wee girl of my life.
“That day in hospital Raychel was dying slowly in front of us. I would just like to ask: When does a doctor or nurse become concerned? How sick do you have to be before anybody will listen or take your concerns on board?”