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Dr Roohi Singh - 'My thoughts are with the family' |
Doctor in baby death probe admits: I made an error
Hearing told of a ‘systemic failure’ at UCLH, inadequate training and reluctance among consultants to help out in casualty
A JUNIOR hospital doctor has admitted he made a mistake when he sent home an eight-month-old baby suffering from a deadly illness.
Albie Jago was diagnosed with tonsillitis at University College London Hospital in Bloomsbury, but later his condition worsened, his lips turned blue and within hours he was dead, a medical tribunal heard this week. He had succumbed to meningococcal septicaemia.
The tribunal in Manchester was told of a “systemic failure” at the hospital, of inadequate training for junior staff, and of senior consultants who were “reluctant” to help them out in the accident and emergency department.
Dr Roohi Singh, 25, who was on duty at the hospital when Albie was brought in, appeared yesterday (Wednesday) at the fitness-to-practice hearing brought by the General Medical Council in Manchester.
He said: “I accept that I made an error of judgment and I deeply regret that. If I could change what I have done I would. I made an error and first and foremost my thoughts are with the family. I cannot change how they feel but I have learned from this.”
Dr Singh said he did not consult with a qualified paediatrician – a medic who specialises in child sickness – because he did not think he needed to with a diagnosis of tonsillitis.
His evidence came on the third day of a hearing that has seen Albie’s family recall the tragedy that unfolded in December 2005. The facts of the case are disputed by all sides and the cross-examination of witnesses has been highly charged.
Challenged by Dr Singh’s lawyers about her evidence, Albie’s mother, Sam Johns, from Bayham Street, in Camden Town, told the inquiry on Monday: “I have not come here to ruin a man’s life. I have come here to tell the truth.”
As she gave evidence, she looked visibly upset, particularly when cross-examined by Dr Singh’s legal team.
Dr Singh received an informal warning by the hospital in writing after the baby’s death but was back working in accident and emergency at UCLH within a year. He is accused of failing to perform proper checks and not seeking advice from his superiors.
A panel of three medical experts must decide whether Dr Singh should be struck off. He is on the brink of becoming fully qualified and is currently working at Keats Practice in Downshire Hill, Hampstead.
The inquiry – expected to run into next week – heard from defence barrister Mary O’Rourke how the hospital was “horrendously busy” and that UCLH’s specialist paediatric ward had been closed due to “understaffing”.
Albie was on an afternoon shopping trip in the West End on December 5 with his mother and his sister, Shelley Wren, 20, when he suddenly became lethargic. A pharmacist advised Ms Johns to take him to UCLH, where a triage nurse took Albie’s pulse and temperature. The inquiry heard how the baby’s heart rate was 208 beats a minute, twice the rate expected for a baby of his age.
She marked an observation card as “category two”, which means the patient must be seen within 10 minutes, but no paediatrician was available and Dr Singh was eventually summoned.
Barrister Richard Pearce, for the GMC, told the hearing that Dr Singh had failed to grasp the significance of Albie’s unusual heartbeat – an accusation rejected by the doctor in evidence.
Finding mucus on the back of Albie’s throat, he diagnosed tonsillitis and prescribed penicillin.
Ms Johns said: “He [Dr Singh] was very adamant that it was tonsillitis. It made me question myself and feel that I was wrong.”
But she added: “It comforted me. It made me think everything was going to be OK. He was so adamant – so sure about it all. I felt reassured. I thought: maybe I’m paranoid.”
Albie’s condition worsened after he was taken home. As his lips turned blue, Ms Johns rang Great Ormond Street Hospital for help. She was told to go directly to the Royal Free Hospital in Hampstead, where she was met by a specialist team who spotted a tell-tale rash developing. Albie was diagnosed with meningococcal septicaemia and died at about 11pm.
Evidence of Dr Singh’s examination of Albie has been disputed. Claims that he did not take the baby out of his push-chair and checked only his ears and throat are contested.
Tony Jago, Albie’s father, said: “He palmed us off. We did not trust what we had been told at UCLH.”
Dr Singh had completed just two days of informal training on how to detect the condition that killed Albie.
“I had no formal training on recognition of a sick child,” he told the inquiry. “There were three of us at UCLH but only one or two of us were able to attend training days because of service commitments. I had not had advice on what a ‘category two’ meant from triage. We had one informal Powerpoint presentation on septicaemia, but no advice cards were available to be distributed.”
He said that when he was called to see Albie he did not go to the specialist paediatric accident and emergency unit because it had been “closed more often than it had been open”.
Dr Singh said he made several observations, including Albie’s pulse, but did not write down his estimate of 180 beats per minute.
“I accept that as a mistake,” he said. “I recognised the pulse was highly abnormal, but I thought it was in synch with Albie’s temperature. I now realise that was not the case. At the time I felt the heart rate was manageable and the diagnosis of tonsillitis allowed for discharge. I would not have expected to consult with a paediatrician over a diagnosis of tonsillitis.”
Experts suggested that Dr Singh was wrong to let Albie go home but added that there was no rule at the time that stopped junior doctors assessing children on their own.
Dr Jane Rosemary Mortem, an expert in emergency childcare and performance assessor for the GMC since 1996, told the panel on Tuesday: “No doctor should discharge a baby with that pulse rate. Anyone working with children should have the awareness and training to know what the vital signs of sickness are.
“But all hospitals need to have some kind of protocol for this so that a junior doctor is not allowed to assess a child on his own. There were no protocols for this at University College Hospital at the time.”
Dr Sian Harding, the lead paediatrician at the hospital who carried out an investigation for Dr Singh’s disciplinary hearing in June 2006, appeared by video-link yesterday (Wednesday).
She said: “The heart rate was very significant and Dr Singh should have known that. But somehow that message had not got across to him. I put that down to systemic failure in the hospital and the fact that he had received inadequate training.
“He had not had the required teaching and induction programme. He had no experience of treating MS [meningococcal septicaemia]. Our report concluded Dr Singh made a mistake in his assessment. I also discovered there was a culture of reluctance among the consultants to come and help in A&E and so junior doctors were reticent to call them for advice.”
The hearing continues. |
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