Some medics behaved ‘evasively, dishonestly and ineptly’, inquiry finds

‘No family should have to go through the mental and physical stress, hurt and undermining that we are still going through’

Marie Ferguson, whose 9 year old daughter Raychel died of hyponatraemia in June 2001, speaks to the media following the publishing of findings of an inquiry by chairman Sir John O’Hara. Photograph:   Brian Lawless/PA
Marie Ferguson, whose 9 year old daughter Raychel died of hyponatraemia in June 2001, speaks to the media following the publishing of findings of an inquiry by chairman Sir John O’Hara. Photograph: Brian Lawless/PA

Doctors covered up failures in patient care, a public inquiry into the hospital deaths of five children in Northern Ireland has found.

Sir John O'Hara QC, a High Court judge, investigated the deaths of five children who were being treated at the Royal Belfast Hospital for Sick Children when they died, although some had been transferred from hospitals in other parts of Northern Ireland.

He examined whether fatal errors were made in the administration of intravenous fluids, and said some medics had behaved “evasively, dishonestly and ineptly”.

The Hyponatraemia inquiry was set up almost 14 years ago. Hyponatraemia is a dangerous, sometimes fatal, condition caused by low sodium levels in the blood.

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The mother of one of the children, Marie Ferguson whose daughter Raychel died in 2001, echoed the inquiry's call for a law forcing doctors to be candid.

She said: “No family should have to go through the mental and physical stress, hurt and undermining that we are still going through.

“I would like in memory of Raychel the introduction of a statutory duty of candour - Raychel’s Law.”

The inquiry chairman said apologies from Northern Ireland’s health authorities had to be dragged out of them through expert evidence to his inquiry.

He was especially critical of an anaesthetist whose patient died during an operation but who failed to acknowledge his errors for many years.

“It is time that the medical profession and health service managers stop treating their own reputations and interests first and put the public interest first.”

The inquiry investigated the deaths of four-year-old Adam Strain, who died in November 1995; Claire Roberts, who died aged nine in October 1996; and nine-year-old Raychel Ferguson, who died in June 2001. It also examined events following the death of 17-month-old Lucy Crawford in April 2000 as well as specific issues arising from the treatment of 15-year-old Conor Mitchell in May 2003. All five children were being treated at the Royal Belfast Hospital for Sick Children when they died, although some had been transferred from hospitals in other parts of Northern Ireland.

The investigation, estimated to have cost in excess of £15 million, has been hit by multiple delays. It was first ordered in 2004 by the then-direct rule minister for health in Northern Ireland Angela Smith after allegations that mistakes had been made by hospital staff administering intravenous fluids.

The inquiry initially examined the deaths of Lucy, Raychel and Adam. Claire and Conor’s deaths were added to the terms of reference in 2008.