I wonder if readers remember this post: Saudi Aramco IPO delayed until 2019. That was
posted a little over a year ago, back in March, 2018. Now, not to anyone's surprise, it is being reported that
the IPO "may slip beyond 2019." All I know is that the kingdom "needs" $100-oil to make the IPO work. At least that was said some time ago. OPEC "basket" is now trading under $73.
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].
