A DOCTOR was asked to speculate on what action he might have taken if a baby - who was later diagnosed with meningitis which caused brain damage - had been admitted to hospital.
Speaking on day four of an inquest Dr Brendan Harrington, a consultant paediatrician at Wrexham Maelor Hospital, said nine-month-old Kate Pierce “probably” would have undergone observations every four hours if she had been a patient on his morning rounds on March 30, 2006.
Kate, of Rossett, was discharged the night before. Mum Diane, who was later joined by her husband Mark, had sought medical help after their daughter had vomitted a “huge amount of green mucus”, the hearing in Abergele was told yesterday.
She was sent home from Wrexham after being diagnosed by then junior doctor, Dr Halenahalli Vijayakumar, with viral tonsillitis.
After her condition deteriorated further Kate was rushed back to hospital on March 31 and was subsequently diagnosed with pneumococcal meningitis.
She was left severely brain damaged and needed round-the-clock care. She died in her sleep during a family trip to Florida aged seven.
Dr Harrington told the hearing that when Kate returned home, after several months of intensive care at Alder Hey Children’s Hospital in Liverpool, she needed to come under the care of the local hospital. As he had not been involved in earlier events, he saw Mr and Mrs Pierce, but the parents later asked to transfer Kate’s care to a hospital in Chester.
“My last involvement was in October 2009. It was nothing about her care being unsatisfactory,” he said.
“It was down to the complaint [the family had made a complaint in 2006 following the events on March 29]. The parents were extremely civil in terms of how they conducted their relationship with me.”
David Lewis, deputy coroner for North East Wales and Central, asked Dr Harrington to “enter the realms of speculation” and to tell jurors what might have been different if Kate had been admitted to hospital.
“On the morning of March 30 I would have looked at the notes by the night staff,” he said.
“I would then have introduced myself to the parents and looked at Kate’s observations chart. We would have probably done four hourly observations.
“If the parents had reported no change overnight, then I would have looked to confirm the diagnosis of tonsillitis. I would have carried out a more extensive examination.”
Dr Harrington said his findings would have “superseded” the assessment made the night before.
“We would have moved on nine hours since then,” he added.
Dr Harrington explained if there had been no change, then it was “likely” he would have discharged Kate, some time around midday.
He would have also made the parents aware of the hospital’s 24 hour access policy, that if Kate’s condition changed, she could return to the hospital.
“It is unlikely Kate would have been kept in. Kate’s parents thought they could carry on normal childcare arrangements,” Dr Harrington said.
Martin Jones, a solicitor representing Kate’s parents, was keen to stress Kate went to her grandparents on March 30 only because Kate was unwell.
“She didn’t go to nursery,” he added. “She went to the grandparents and her mum left work early.”
When Dr Harrington said he had not had any interaction with Kate’s parents since 2009, Mrs Pierce left the room and returned visibly upset a short while later.
He went on to say: “Kate was a very much loved child and their loss is very much irreplaceable. Nothing is going to change that.”
Dr Vijayakumar told the hearing on Wednesday that he had no recollection of events of March 29, 2006, and he could only provide answers based on the findings and notes he made at the time.
Dr Simon Nadel, consultant in paediatric intensive care at St Mary’s Hospital in London, was called to the inquest to speak as an independent expert.
He said in his opinion Kate presented “clear features” of meningitis on March 31.
“It doesn’t mean that because they weren’t clear on March 29, that she didn’t have clear features of meningitis,” he said.
Dr Nadel was asked if Dr Vijayakumar’s diagnosis had been reasonable.
“It is reasonable,” he said. “It is hard to be definite.
“Based on the symptoms, it is reasonable to come to that diagnosis.
“It is very easy to say it is viral because 95 per cent of the time, you will be right,” he added.
“The point of the medical specialist’s opinion is to see if you are missing something. Something that is possible even if it is not probable.”
Dr Nadel said he could see discrepancies between the parents’ account – that their child was asleep – and the account of the medical professionals.
“If Kate was completely unresponsive, that would be recognised immediately,” he said.
“A child so sleepy [during examination. That worries me.
“Kate should have been admitted and a investigation should have gone on, but that is easy for me to say.
“If she was clearly unresponsive, it would have been a medical emergency – that she wasn’t capable of being roused.
“Children don’t like being examined so to be asleep throughout, I would consider that to be abnormal.”
Dr Nadel said if Kate had been given intravenous antibiotics on March 30, meningitis might have been prevented.
The inquest continues.