Hyponatraemia: Trust withheld information from inquest
A health trust effectively withheld evidence from an inquest investigating the death of a child in hospital.
The claims were made by the chairman of the hyponatraemia inquiry into events surrounding the deaths of five children in Northern Ireland hospitals.
John O'Hara QC said, in other cases, hospital managers rewrote statements and medical professionals 'circled the wagons' in a culture of defensiveness.
He said information was "underplayed or withheld".
The inquiry is looking into the deaths of three children, the events following the death of another and a number of issues arising from the death of a fifth.
The issues of fluid management and hyponatraemia are central to the cases of each of these children.
Mr Justice O'Hara said that, while the inquest was examining five deaths, it was possible that many more deaths of children from hyponatraemia had never been disclosed.
He was speaking after the inquiry heard evidence from the Northern Ireland coroner John Leckey.
Mr Leckey said that he had never even been made aware of an expert report commissioned by the Altnagelvin Health and Social Services Trust (now part of the Western Trust) into the death of nine-year-old hyponatraemia victim Raychel Ferguson, who died in 1991.
The report appeared to contradict an earlier version of events given by the trust.
Mr O'Hara said the underplaying and withholding of information had been an underlying theme throughout the inquiry and that the inquiry was aware of statements by medical staff that had been rewritten by hospital management "in order to control the information to us".
"Here we have one public body (the coroner's office) investigating the death of a child, and another public body (the health trust) withholding an expert's report from them simply because it's inconvenient for them," he said.
Mr Leckey, who is now the coroner for Greater Belfast, told the inquiry it was crucial that medical witnesses were always open and transparent in inquests.
"Transparency has to come from medical staff, not only for me, exercising a judicial function, but for the bereaved families," he said.
A lawyer for the inquiry, however, suggested to Mr Leckey that there had been a "defensive and protective culture" within the medical profession where "successes were trumpeted and failures kept quiet".
Mr Leckey acknowledged this but added that he believed the culture was changing.
He said one of the reasons for this was that the medical profession was being encouraged to admit if something had gone wrong.
"Bereaved families are also much more likely to question information that they have been given," he said.
Mr O'Hara agreed that things had improved but said that, in the past, "the bar was set so low" it would have been impossible not to make progress.
"I accept some things have changed. It's how much they've changed and what more can be done," he said.
"We are focussing on five children, but nobody knows if there are many more hyponatraemia deaths that have never been disclosed. Two of the cases we are examining here only came to light, effectively, by accident."
Earlier, Mr Leckey told the inquiry that he was "shocked, disappointed and very upset" to learn that best practice guidelines on the condition were not circulated to all hospitals in Northern Ireland as far back as the mid-90s.
The draft guidelines were produced during the inquest into the death of four-year-old Adam Strain in 1995.
Mr Leckey said he had been shocked to learn that the most senior people at the Royal Belfast Hospital for Sick Children had not been told about the proposed guidelines.
He said that, at the time, he had been "very, very concerned" that the message about fluid management and hyponatraemia was disseminated as widely as possible in Northern Ireland and throughout the UK.
Hyponatraemia is the term for a low level of sodium in the bloodstream causing the brain cells to swell with too much water.