Low ‘Na’ not onmy radar: Doc

Dr Michael Curran, who now works as a GP in Magherafelt and Limavady, said he was standing in for a colleague on the evening of June 8, 2001, when he was called to attend Raychel to administer an anti-emetic due to her continued vomiting.

The nine-year-old died after a saline drip was administered after an appendix operation at Altnagelvin. Raychel was given a weaker sodium solution (No. 18) after initially being prescribed a stronger concentration (Hartmann’s).

Raychel ultimately died as a result of the complications arising from the development of hyponatraemia - a condition brought on by low blood sodium.

The Inquiry has already heard how Dr Ragai Reda Makar’s decision - the surgeon is scheduled to provide evidence today - to treat Raychel with a sodium-rich intravenous solution was overruled due to it not being “consistent with common practice” in the Altnagelvin children’s ward.

Dr Curran has now advised the Inquiry that he attended Raychel at approximately 22:00 hours to deliver an anti-emetic to allay continued vomiting.

He said he had been on call as a ‘surgical’ Junior House Officer (JHO) at Altnagelvin on the night of Raychel’s deteriorating illness because a colleague had been absent, possibly through illness.

He was on placement at the Londonderry hospital between August 2000 and August 2001 and said the year was divided into two six month periods, one of which was spent in ‘surgery’ and the other in ‘medicine.’

On the day Dr Curran attended Raychel he had been on his six month ‘medicine’ placement. He told the Inquiry he was quite inexperienced as far as paediatrics were concerned.

Dr Curran said he saw paediatric patients no more than a dozen times during his year-long spell as a junior doctor at Altnagelvin.

And he said that as far as he could remember his care of Raychel was his last involvement in a paediatric case whilst he was at Altnagelvin.

He also said he had no recollection of any fluid management training at the hospital and that whilst he would have understood what hyponatraemia meant in the sense that ‘hypo’ meant low and ‘natraemia’ meant sodium the condition “would not have been on his radar in 2001.”

Dr Curran told the Inquiry: “As far as I can honestly recollect, there was no training on fluid balance. The fluid balance training in the surgical directorate would have been either one of the Senior House Officers (SHO) or one of the nurses telling you someone’s going to be on this fluid, Solution No. 18, or someone’s going to be on normal saline, one bag every eight hours.

“This concept you’re saying now about vomiting and losing electrolytes - I mean since 2001 and in my medical training I understand the concept of vomiting and diarrhoea and the electrolyte loss.

“Back in 2001, if a patient was vomiting, thinking about electrolyte abnormalities or loss of sodium wouldn’t even have occurred to me.”

The Londonderry doctor said that when he was paged to attend Raychel because of her continued vomiting she didn’t look distressed.

He stated: “I was coming to give an anti-emetic for someone who was vomiting. This is something we do commonly as a JHO. When you do see someone, you’re obviously going to take in some information, you’re going to look at the patient.

“When I seen Raychel, Raychel was not vomiting when I seen her. She wasn’t retching and didn’t look distressed when I’d seen her. I was only with Raychel for maybe 10 minutes in total, at most.”

He went on to tell the Inquiry that Raychel’s eyes were open and she greeted him when he arrived.

“I think all she said to me was ‘hi,’ ‘hello,’ something like that,” he said.

As the Sentinel went to press yesterday the Inquiry was due to hear from Dr Bernie Trainor, a Second Term Paediatric SHO in Altnagelvin at the time of Raychel’s death.

Dr Trainor was asked to attend Raychel after 04:00 hours on June 9, 2001, as her condition deteriorated further.

Raychel’s father Ray who arrived back at Altnagelvin at about 04:00 hours has stated that it was “complete chaos” and he recalls Raychel “shaking” and “trembling” at this time.

Today the Inquiry is scheduled to hear from Dr Makar, who performed Raychel’s appendicectomy and also put her on the lower level sodium drip when advised by a nurse at the hospital that it was normal practice to do so at Altnagelvin.

The Inquiry is also scheduled to hear from Dr Brian McCord who was the Consultant Paediatrician on call at the time. Dr Trainor asked him to “come in immediately” shortly after she first assessed Raychel after 04:00 hours on June 9.