I track the IPO milestones here.
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Nothing To Do With The Bakken
For The Archives
Posted For A Number Of Reasons
Link here for the complete article and I think it's a free link.
From the current edition of The London Review of Books.
On the morning of February 18, 2011, Jack Adcock, a six-year-old boy, was brought into Leicester Royal Infirmary with diarrhea and vomiting.
He died eleven hours later.
The pediatric physician looking after him was convicted in November, 2015, of manslaughter by gross negligence, and in January, 2018, she was struck off the medical register (disbarred, as it were from ever practicing medicine again, in England).
Jack Adcock, the six-year-old, had Down’s syndrome and had previously undergone surger to repair a congenital heart condition.
When he arrived at the infirmary, after twelve hours of diarrhea and vomiting, he was described as being unresponsive. Initial blood test showed high levels of lactate and acid in his blood, which can be the result of shock, a secondary condition in cases of sepsis or dehydration.
The pediatrician (in training, by the way) attributed [the abnormal blood results] to dehydration caused by gastroenteritis and treated Jack with IV fluids. His bloods (sic) improved (although not back to normal values), he woke up, and he was observed drinking and playing.
While waiting for the results of further blood tests and a chest x-ray, the pediatrician (in training, by the way) went to see the many other patients she was responsible for that day, including a baby who needed a lumbar puncture for possible meningitis.
The pediatrician, who was in her sixth year of specialist training, was doing the work of two doctors, covering the children’s assessment unit (CAU) and referrals from [the emergency room] and [and other outside physicians] while the other pediatrician (also in training) was away on a training day (no cover had been provided).
The on-call consultant for the CAU was not in the hospital until the afternoon. The rest of the team consisted of two far more junior physicians who were beginning their pediatric rotations — one of them spent the whole afternoon on the phone to the laboratory getting blood results because the IT system was down.
The results of the blood tests that the pediatrician requested when Jack first arrived did not come back for six hours because of the IT issues. The pediatrician did not see the chest x-ray until three hours after it had been done. It showed pneumonia and she prescribed antibiotics.
It was a further hour before the antibiotics were administered by the agency nurse who wasn’t trained in pediatrics.
She, too, has been convicted of manslaughter for not adequately monitoring Jack or alerting the pediatrician to his deterioration [in fact, he had improved; he was seen drinking and playing].
The prosecution argues that the pediatrician had not reviewed the chest x-ray and blood results quickly enough, and that she should have started the antibiotics earlier and should have “escalated” her concerns to the on-call consultant, Dr Stephen O’Riordan, who was informed of Jack’s case and results at the usual 4:30 p.m. handover but didn’t review him (he has suffered no repercussions). O’Riordan has stated that he wasn’t asked to review Jack, but it would be reasonable to assume that a doctor of his seniority and experience would have made his own assessment of the seriousness of Jack’s condition (a child who had apparently recovered nicely with IV fluids, and was now drinking and playing; I doubt any senior consultant would have been “interested” in reviewing the case or the patient at that point): a consultant will often review a worrying case without being expressly asked to do so, and the Royal College of Paediatrics and Child Health recommends a consultant review of every patient within twelve hours of admission.
On the day of Jack’s death, the CAU was so busy that the pediatrician worked her 13-hour shift without a break.
It is worth nothing that she had only just come back after maternity leave, she was working in a hospital that was new to her, and she had received no induction from the [National Health Service].
At 7:45 p.m. Jack’s heart stopped and a crash call was put out alerting the medical team, including the pediatrician (who must have been in her 12th hour of work without a break).
Forty-five minutes earlier Jack had been given his regular medication, enalapril, a drug used to treat high blood pressure by his month.
The pediatrician had specifically not prescribed the enalapril as it can precipitate cardiac arrest in a patient who already has low blood pressure due to shock (at her trail she was criticized for not making it clear to the mother not to administer it).
Resuscitation was started, but briefly stooped because the physician in charge (the pediatrician who was in her 12th hour of a 13-hour shift; just off maternity leave; in a new hospital) thought a “do not resuscitate” order was in place. The inquest (surprisingly) ruled that this interruption did not contribute to Jack’s death as his condition was by then too far advanced. (Surprising, not because the inquest was correct in this matter, but the prosecutor could have easily gotten a bigger damage award had he pressed this issue; I guess the prosecutor felt that destroying the pediatrician’s livelihood and career was enough).
Jack was declared dead at 9:20 p.m.
Then, much more soul-searching continues.
At the end of the day, the pediatrician was found guilty of gross negligence manslaughter. She received a suspended sentence of two years’ imprisonment and was order to pay 25,000 English pounds to the prosecution. In 2017, the Medical Practitioners Tribunal Service imposed a 12-month suspension from the medical registrar (effectively disbarring her from practicing medicine in the UK, concluding that the pediatrician did not pose a continued risk to patients. This was challenged by the General Medical Council in the High Court — an unprecedented move — and the judge agreed to her permanent erasure from the medical register [from the National Health Service].
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