Doctor in death case 'trying to justify the unjustifiable'

Chris Donegan • Published 29 Oct 2009 09:00 0 Comments

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The doctor responsible for looking after Lucy Crawford the night she was given a fatal overdose of fluid has been accused of trying to justify the unjustifiable.

Dr. Jarleth O'Donohoe said that even if he had written down the prescription of what the 17-month-girl was to be given he was not sure she would still be alive.

The GMC(General Medical Council), which is responsible for ensuring doctors maintain proper standards, accuses him of not acting in Lucy's best interests and that his treatment of her fell below the standard expected of a reasonably competent paediatrician. It says he was guilty of gross professional misconduct.

Dr. O'Donohoe disputed some of the evidence of a GMC expert, Dr. Dewi Evans, on the treatment of children with dehydration and maintained that giving a mixture of fluids by mouth and intravenously often led to a more rapid recovery.

However, the GMC's barrister, Mr. Nigel Grundy, said this mix-and-match approach "seems to be a poor attempt on the part of Dr. O'Donohoe to justify or prove some logic to his alleged prescription and recollections he wrote down" two days after Lucy died.

"It doesn't bear close scrutiny. It is a misconceived attempt to rely upon the words 'encourage feeding' and to turn that into some sort of plan of oral rehydration. If that was really his plan then why did he not instruct anyone that oral rehydration should continue and what was expected to be given by way of oral rehydration," asked Mr. Grundy.

"With the greatest respect to the doctor it is trying to justify the unjustifiable. Trying to justify what he wrote down, which in Dr. Evans evidence was illogical and illogical in clinical terms," the barrister submitted.

Dr. O'Donohoe told the hearing: "If I had written everything down the last 10 years would have been different for me - I am not entirely persuaded the outcome would have been different for the patient in question."

Mr. Grundy said: "He had not written down the instruction and said it wouldn't make any difference in this case - is that justifying the unjustifiable?

"If you look at Nurse Swift's evidence she asked: 'What do you want put up?' The bag was put up in his presence. He has made a very poor attempt to try and come up with reasons why he never saw the bag.

"It's really incredible. Even his recall of the instruction is an instruction that is inherently vague and would lead to confusion," the barrister added.

"He just did the calculation in his head in a matter of seconds. It was his prescription, but he seems to rely on technicalities about who wrote it down. He didn't ask Dr. Malik to write it down, but he saw him writing out of the corner of his eye as he was talking. He doesn't know if he was writing the prescription or records," Mr. Grundy argued.

Earlier Dr. O'Donohoe told the hearing: "There is a constant alarm bell in my mind - asking have you recorded enough information to try to ensure this couldn't - wouldn't - happen again."

"Nobody is God. If I do something that doesn't seem to be appropriate, and all my colleagues have agreed, that we should question what is done is our intention. We should all try and follow the procedure and not make short cuts.

"I don't think there is a day passed since that time when I wasn't aware of what happened," he added.

Wiping away tears as he spoke about the tragedy in April 2000 he said: "It was a very intense and distressing experience and one that I suppose in many respects I and others will never recover from.

"I don't say that in any sense to minimise the loss of the family. I don't say that it is anything like the loss of a child," he added.

"I was unable to work for a significant period of time - approximately a year - as a result of the total consequences of this both on me and on my family," he stated.

Dr. O'Donohoe revealed that the very intense local interest in the case had impacted on his life outside work.

"There was a very strong local feeling and it was made plain to my family - particularly my daughter - who had anonymous and abusive phone calls about this event," he told the hearing.

"In terms of publicity and unwanted attention a number of people working in the children's ward felt a lot of pressure," he added.

He said he had not given evidence at Lucy's inquest in 2004 on legal advice.

He denied ever being dishonest in his dealings in the case.

Dr. O'Donohoe revealed that many changes had been implemented at the hospital since the tragedy and among those was a named patient nursing system where individuals were allocated a named nurse responsible for them during their stay.

He added that there had also been a large number of changes with regards to sheets relating to intravenous fluids both for prescription purposes and recording amounts given.

He also revealed that when he gave the disputed prescription of a bolus of 100mls that he looked round and saw his Senior House Officer Dr. Malik writing in the medical notes. He had presumed at that point that his junior was recording the verbal instruction, but it transpired that was not the case.

He wanted proper notes made of the height, weight and head circumference of children on the ward and had asked everyone involved in paediatrics to detail what they felt should be recorded.

He also asked for a respected text book to be made available on the ward, but his request was repeatedly refused by the then Western Health Trust.

Dr. O'Donohoe also revealed that repeated requests for a paediatric ventilator were also refused by the Trust and on the night little Lucy was transferred to the Royal Victoria Hospital in Belfast both he and an intensive care nurse had to deal with her resuscitation by hand with a bag.

He said: "We had to hand ventilate her all the time as the Trust had refused repeated requests to have a paediatric ventilator for this kind of situation."

This article appeared in Impartial Reporter 29 Oct 09

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