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I'm Happy To See A Nurse Done For Manslaughter

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Post by BigAndy9 Mon Nov 02, 2015 6:33 pm

2nd November 2015

One or two of you may remember my campaigns on forums to see doctors and nurses treated the same as other trades instead of being on a pedestal.

Please discuss.



A nurse has been found guilty of the manslaughter of a six-year-old boy whose resuscitation was mistakenly called off.

Jack Adcock, who had Down's syndrome, died of a cardiac arrest at Leicester Royal Infirmary in February 2011.

Portuguese-born agency nurse Isabel Amaro, 47, was found guilty of manslaughter by gross negligence.

The jury is deliberating on the same charge for two other medics - Dr Hadiza Bawa-Garba and nurse Theresa Taylor.

Jack, who had a heart condition, was admitted to the hospital with pneumonia and died from a cardiac arrest after sepsis was triggered by a bacterial infection about 11 hours later.
The trial has heard the boy's death was caused by "serious neglect on the part of the doctor and the two nurses".


http://www.bbc.co.uk/news/uk-england-leicestershire-34704404
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Post by Raggamuffin Mon Nov 02, 2015 7:10 pm

It's quite unusual isn't it? The boy was very ill with sepsis anyway. Could they have saved him with treatment?
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Post by BigAndy9 Mon Nov 02, 2015 7:16 pm

Raggamuffin wrote:It's quite unusual isn't it? The boy was very ill with sepsis anyway. Could they have saved him with treatment?

Well, probably.

As you can see from the last line in the first post, plus:

The prosecution had said Amaro's record-keeping of the boy's life signs, regarded by experts as basic nursing practice, had been "woefully inaccurate".
The court was also told that Dr Bawa-Garba - who along with Ms Taylor denies the manslaughter charge - had mixed him up with another patient and mistakenly believed he had a "do not resuscitate" order.
She ordered resuscitation to start again a few minutes later, after another doctor checked the boy's notes.


And the conviction of manslaughter?
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Post by Raggamuffin Mon Nov 02, 2015 7:40 pm

I read that the resuscitation thing had no bearing on his death though. Is it not up to doctors to treat patients for sepsis? I would have thought a doctor could see what was wrong with the kid without a nurse keeping notes. I'm not sure what this nurse did wrong, but I expect we'll hear more.

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Post by Raggamuffin Thu Nov 05, 2015 8:49 am

The doctor was found guilty as well. Theresa Taylor, the ward sister, was cleared - that must have been a big relief to her.

I'm quite surprised tbh because I'm not sure that the negligence caused the boy's death. Maybe this will encourage doctors and nurses to pay more attention though - or it might encourage them to think it's not worth going into that profession because they're going to be prosecuted for mistakes.
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Post by Raggamuffin Thu Nov 05, 2015 9:41 am

I'd like to know more about this senior colleague who came onto the ward at 4.30. Didn't that colleague do his own checks?

Between 4pm and 7pm, Dr Bawa-Garba didn't check on Jack, who was suffering constant diarrhoea, at all, or flag up his condition to a more senior colleague when he came on the ward at 4.30pm.

http://www.telegraph.co.uk/news/uknews/crime/11975150/Hospital-doctor-found-guilty-of-manslaugher-after-blunders-left-a-six-year-old-boy-dead.html

I also note that Dr Bawa-Garba seemed to have been on duty for a long time - she was there at 10.30 when the boy was admitted, and still there at 7.45 when he went into cardiac arrest, and was probably there when he died. Did she habitually do long shifts and was perhaps tired?

If all three missed the signs of sepsis when he was brought in, does that suggest that it wasn't that obvious?



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Post by BigAndy9 Thu Nov 05, 2015 12:03 pm

Raggamuffin wrote:The doctor was found guilty as well. Theresa Taylor, the ward sister, was cleared - that must have been a big relief to her.

I'm quite surprised tbh because I'm not sure that the negligence caused the boy's death. Maybe this will encourage doctors and nurses to pay more attention though - or it might encourage them to think it's not worth going into that profession because they're going to be prosecuted for mistakes.

Good. Now send them down for a long time!
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Post by Raggamuffin Thu Nov 05, 2015 2:57 pm

I'm just not sure it should have come to a criminal trial. Maybe they made mistakes, maybe they didn't pay enough attention, or maybe they just didn't recognise the signs of sepsis, but they didn't maliciously neglect the boy did they? He did have tests, an X-ray, and antiobiotics, just not soon enough, or they didn't look at the results properly.

There are loads of stories about patients being sent home when they shouldn't be, patients being misdiagnosed, doctors not communicating with each other, or giving the wrong treatment. I wonder if these two have been made scapegoats because it was a kid with Down's syndrome who died, and because of the mistake re the resuscitation.
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Post by BigAndy9 Thu Nov 05, 2015 5:28 pm

Raggamuffin wrote:I'm just not sure it should have come to a criminal trial. Maybe they made mistakes, maybe they didn't pay enough attention, or maybe they just didn't recognise the signs of sepsis, but they didn't maliciously neglect the boy did they? He did have tests, an X-ray, and antiobiotics, just not soon enough, or they didn't look at the results properly.

There are loads of stories about patients being sent home when they shouldn't be, patients being misdiagnosed, doctors not communicating with each other, or giving the wrong treatment. I wonder if these two have been made scapegoats because it was a kid with Down's syndrome who died, and because of the mistake re the resuscitation.

Manslaughter by gross negligence Ragga - the same as a plumber who does a crap job on the boiler or fire would be sent down.

Good to see some who are normally untouchable get the same treatment.
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Post by Raggamuffin Thu Nov 05, 2015 5:37 pm

BigAndy9 wrote:
Raggamuffin wrote:I'm just not sure it should have come to a criminal trial. Maybe they made mistakes, maybe they didn't pay enough attention, or maybe they just didn't recognise the signs of sepsis, but they didn't maliciously neglect the boy did they? He did have tests, an X-ray, and antiobiotics, just not soon enough, or they didn't look at the results properly.

There are loads of stories about patients being sent home when they shouldn't be, patients being misdiagnosed, doctors not communicating with each other, or giving the wrong treatment. I wonder if these two have been made scapegoats because it was a kid with Down's syndrome who died, and because of the mistake re the resuscitation.

Manslaughter by gross negligence Ragga - the same as a plumber who does a crap job on the boiler or fire would be sent down.

Good to see some who are normally untouchable get the same treatment.

It's not really the same because the boy had sepsis when he was brought in - they didn't cause the infection.
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Post by BigAndy9 Thu Nov 05, 2015 6:43 pm

Raggamuffin wrote:
BigAndy9 wrote:

Manslaughter by gross negligence Ragga - the same as a plumber who does a crap job on the boiler or fire would be sent down.

Good to see some who are normally untouchable get the same treatment.

It's not really the same because the boy had sepsis when he was brought in - they didn't cause the infection.

Errrm... well it is the same

The trial has heard the boy's death was caused by "serious neglect on the part of the doctor and the two nurses".

And they are guilty of causing death by gross negligence, resulting in a verdict of guilty for manslaughter.

Also, why do you keep saying he had sepsis?

Jack, who had a heart condition, was admitted to the hospital with pneumonia and died from a cardiac arrest after sepsis was triggered by a bacterial infection about 11 hours later.

Mrs Adcock described their son as lively and energetic.
"You take your child to the hospital expecting you are doing the right thing.
"I wish I had never taken him there that day," she told the BBC.
"They neglected him from the minute he went into that ward."

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Post by Raggamuffin Thu Nov 05, 2015 6:49 pm

BigAndy9 wrote:
Raggamuffin wrote:

It's not really the same because the boy had sepsis when he was brought in - they didn't cause the infection.

Errrm... well it is the same

The trial has heard the boy's death was caused by "serious neglect on the part of the doctor and the two nurses".

And they are guilty of causing death by gross negligence, resulting in a verdict of guilty for manslaughter.

Also, why do you keep saying he had sepsis?

Jack, who had a heart condition, was admitted to the hospital with pneumonia and died from a cardiac arrest after sepsis was triggered by a bacterial infection about 11 hours later.

Mrs Adcock described their son as lively and energetic.
"You take your child to the hospital expecting you are doing the right thing.
"I wish I had never taken him there that day," she told the BBC.
"They neglected him from the minute he went into that ward."


I read that they missed the signs of sepsis when he was brought in. I also read that he was given antibiotics, although not straight away.

He couldn't have been that lively if he had a heart condition, and they haven't said what kind of heart condition he had.

He was vomiting when he was brought in, so I don't think someone would immediately think of pneumonia.

The details in this case differ from site to site, but I'm just a bit uncomfortable with this criminal prosecution.
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Post by BigAndy9 Thu Nov 05, 2015 7:01 pm

Raggamuffin wrote:
BigAndy9 wrote:

Errrm... well it is the same

The trial has heard the boy's death was caused by "serious neglect on the part of the doctor and the two nurses".

And they are guilty of causing death by gross negligence, resulting in a verdict of guilty for manslaughter.

Also, why do you keep saying he had sepsis?

Jack, who had a heart condition, was admitted to the hospital with pneumonia and died from a cardiac arrest after sepsis was triggered by a bacterial infection about 11 hours later.

Mrs Adcock described their son as lively and energetic.
"You take your child to the hospital expecting you are doing the right thing.
"I wish I had never taken him there that day," she told the BBC.
"They neglected him from the minute he went into that ward."


I read that they missed the signs of sepsis when he was brought in. I also read that he was given antibiotics, although not straight away.

He couldn't have been that lively if he had a heart condition, and they haven't said what kind of heart condition he had.

He was vomiting when he was brought in, so I don't think someone would immediately think of pneumonia.

The details in this case differ from site to site, but I'm just a bit uncomfortable with this criminal prosecution.

OK, leaving this case to one side - don't you think that medics seem to get away with things far too much - it being put down to "mistakes" and being dealt with at tribunals with suspensions or more training being the "punishment" whereas every other trade is dealt with by criminal proceedings?
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Post by Raggamuffin Thu Nov 05, 2015 7:09 pm

BigAndy9 wrote:
Raggamuffin wrote:

I read that they missed the signs of sepsis when he was brought in. I also read that he was given antibiotics, although not straight away.

He couldn't have been that lively if he had a heart condition, and they haven't said what kind of heart condition he had.

He was vomiting when he was brought in, so I don't think someone would immediately think of pneumonia.

The details in this case differ from site to site, but I'm just a bit uncomfortable with this criminal prosecution.

OK, leaving this case to one side - don't you think that medics seem to get away with things far too much - it being put down to "mistakes" and being dealt with at tribunals with suspensions or more training being the "punishment" whereas every other trade is dealt with by criminal proceedings?

From my own experience I know about things like misdiagnosis, taking too long to analyse test results, not checking hospital records, etc. I'm just not sure that in this case what they did or failed to do actually led to the death of the boy. It seems to take ages to get anything done in hospitals these days, so I'm not convinced that they're any more guilty than others - except in other cases small boys with Down's Syndrome aren't usually involved.
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Post by BigAndy9 Thu Nov 05, 2015 7:12 pm

Raggamuffin wrote:
BigAndy9 wrote:

OK, leaving this case to one side - don't you think that medics seem to get away with things far too much - it being put down to "mistakes" and being dealt with at tribunals with suspensions or more training being the "punishment" whereas every other trade is dealt with by criminal proceedings?

From my own experience I know about things like misdiagnosis, taking too long to analyse test results, not checking hospital records, etc. I'm just not sure that in this case what they did or failed to do actually led to the death of the boy. It seems to take ages to get anything done in hospitals these days, so I'm not convinced that they're any more guilty than others - except in other cases small boys with Down's Syndrome aren't usually involved.


Good point there - you could have something! Maybe that's one of if not the main reason this one was pursued.

As for the rest - the trial lasted 1 month - i'm sure every avenue was checked, expert analysis, witnesses etc..
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Post by Raggamuffin Thu Nov 05, 2015 7:19 pm

BigAndy9 wrote:
Raggamuffin wrote:

From my own experience I know about things like misdiagnosis, taking too long to analyse test results, not checking hospital records, etc. I'm just not sure that in this case what they did or failed to do actually led to the death of the boy. It seems to take ages to get anything done in hospitals these days, so I'm not convinced that they're any more guilty than others - except in other cases small boys with Down's Syndrome aren't usually involved.


Good point there - you could have something!  Maybe that's one of if not the main reason this one was pursued.

As for the rest - the trial lasted 1 month - i'm sure every avenue was checked, expert analysis, witnesses etc..

I think it is why, and also because of the mistake re the resuscitation thing. That didn't affect the outcome, but it was a bad mistake and it drew attention to the whole thing.

I'd like to know more about how the boy got pneumonia in the first place, and how that led to sepsis.

The doctor said she was waiting for the test results before she gave him antibiotics because she needed to know which one to give him. I don't know how quickly those results were available, but it sounds to me like there's an awful lot of second guessing going on, and being wise after the event, etc.

I think there is a general lack of communication in hospitals, and I think that patients - or the parents in the case of young children - really need to nag at the staff, and ask a lot of questions about what they intend to do re treatment, or why they gave a certain treatment. I've had to do that myself.
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Post by Raggamuffin Thu Nov 05, 2015 7:51 pm

It just seems that it was the doctor's failure to diagnose the sepsis which was the problem. If every doctor was taken to court for failing to diagnose a condition, there would be hardly any left.

If the doctor really thought that the best thing was to be sure what kind of infection he had before she treated him, she was being cautious in not wanting to give him the wrong treatment surely.

These three women were all experienced, and I find it hard to believe that they all missed the signs through negligence.

I don't know - a lot of hospitals are in the dog house these days, and the issues are usually lack of staff, long working hours, and lack of money and resources.
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