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Doctor 'laughed at' consultant plea
A junior doctor was laughed at by a senior colleague when she suggested a consultant should examine a four-year-old girl who died hours later after suffering a severe infection, an inquest has heard.
Freya Wells, from Wallington, Surrey, died at Kingston Hospital after being admitted for breathing difficulties, vomiting and diarrhoea.
Dr Hilary Towse, who was a paediatric senior house officer (SHO) at the hospital, told West London Coroner's Court today that she tried to convince paediatrics registrar Dr Rosita Ibrahim to call for a consultant in the early hours of November 22, 2012.
She also said she thought Freya should be given rapid fluids though a bolus and intravenous (IV) drugs rather than oral, but Dr Ibrahim disagreed with her.
"I specifically said that she needed to have a bolus, I specifically said that she needed to have IV antibiotics and I specifically said that she would need intensive care," Dr Towse told the inquest.
"She thought what I was saying was ridiculous," she said.
Dr Towse began to cry as she added: "I do recall that she laughed."
When asked why she did not contact the consultant herself, she replied: " It will always be something I'll regret for the rest of my life.
"It would never normally be the role of the SHO to do that. Probably I had some experiences where I've been entirely appropriate to speak to a consultant but they would not want to speak to me because I was the SHO."
Nurse Kate Lynch, who also cared for Freya at the hospital, told the hearing that she disagreed with Dr Ibrahim that the youngster should be given intravenous rather than oral antibiotics.
Richard Baker, representing Freya's family, asked her: "Are you saying on this occasion the doctor was wrong?"
Ms Lynch replied: "I felt that she should have had intravenous antibiotics."
The inquest heard that Freya died at 5.45am after suffering from septic shock.
Assistant coroner Dr Sean Cummings told Dr Ibrahim that many clinicians have given evidence that they asked her about the antibiotics.
"There seems to have been a great concern that Freya should have been given IV antibiotics," he said.
"Everybody seems to be clear that you decided that wasn't going to be the case."
Dr Ibrahim, who first saw the girl at 10pm the previous evening, told the court that, despite Freya's high heart and respiratory rates, she followed guidelines which stated that children suffering from severe pneumonia should be given oral antibiotics to reduce their discomfort.
But she said it was planned for the next dose of antibiotics - due at 7am - to be given by IV.
"I realise now it should not have been the case," she said. "She should have received intravenous antibiotics right after her vomit in A&E."
Dr Ibrahim accepted Mr Baker's assertion that it should have taken "a matter of minutes" to see that Freya was seriously ill.
"I just simply did not appreciate how unwell Freya was," she added.
Dr Ibrahim insisted that she had "no recollection" of laughing "at anything" on that night, and told the inquest that, from her memory, the only staff member who came to her with concern was Dr Towse.
"I have been over that evening so many times in my head and I cannot recollect multiple people coming up to me and telling me how concerned they are," she said.
"It is my normal practice to listen to nurses. They are very experienced. If they are concerned then I take it on board."
She added: "Had I known that the nurses were very worried about her I would have just called the consultant straight away."
The inquest was adjourned until 10am tomorrow, when the final evidence is expected to be heard.