CHILD'S DEATH (WOLVERHAMPTON) (Hansard, 15 March 1972)

§ Mrs. Renée Short (Wolverhampton, South-East)
I close the proceedings of Parliament today, having very much earlier in our proceedings had the pleasure of moving a Ten-minute Rule Bill.
I wish to take this opportunity of raising the matter of the death of a three-month-old child, Ravinder Singh Dhadral, who died at home just after Christmas. This was the child of a family who 726 suffered a similar death some time ago when a four-month-old baby girl died of pneumonia, as did the baby whose case I am drawing to the attention of the House. The baby died 12 hours after being turned away from the Royal Hospital, Wolverhampton.
These sad events began on 22nd December when the father called the local doctor to see the baby, who was ill. The doctor gave the child penicillin and made out a prescription, but the baby's condition worsened and the family became very concerned about its condition. On the evening of Christmas Day, which was a Saturday, the locum was again called. He gave more medicine to the baby and made out another prescription.
During Sunday, the father searched in vain for a chemist's shop that was open. I am not criticising the arrangements made for notifying the public about the chemists' rota. I am satisfied that all chemists in Wolverhampton display the rota on their doors. Obviously the father did not know this. Nor did he get in touch with the police, who could have told him where to take the prescription.
727 Unable to find a chemist's shop open, the father took his wife and the baby to the casualty department at the Royal Hospital. Whoever was on duty there refused to call a doctor. As the hospital pharmacy was closed, he could not have the prescription dispensed, and the father said: They gave me two telephone numbers which I rang from the casualty department, but I got no answer. While waiting for a taxi my wife was in tears, and she showed the baby to the receptionist, but she was just ignored. We stayed up nursing Ravinder until 4 a.m."— that would be the Monday morning— but when we woke he was dead. At the inquest on the baby, which was not held until 9th February, the pathologist who carried out the post-mortem reported that the prescription given by the locum would not have had much effect because what was needed was an antibiotic because of the baby's condition. The medicine prescribed was not an antibiotic. I am not dealing with that matter. I am not raising the question of the doctor who prescribed medicine which was useless in this case. But, as it turned out, it reinforced the need for the child to be seen by a doctor when taken to hospital and to be admitted to the hospital. If similar medicine was prescribed before the visit to the hospital, it is not surprising that the child's condition deteriorated.
According to the report of the inquest, in The Times, there was a sister in charge of the casualty department at the time, but her evidence indicates that the parents were anxious only about having the prescription dispensed and that neither parent asked to see a doctor. The father has maintained all along that he asked both for the prescription to be dispensed and for a doctor to see the child. The sister's evidence was not corroborated by the receptionist on duty at the time, who admitted at the inquest that the father in fact asked to see a doctor.
I have already taken up with the Minister the question of casualty cover at this hospital. I wrote to him last October after a constituent of mine complained that his wife was kept waiting a very long time in the out-patients' department. The answer from the Minister then was that doctors had been arriving late on duty, and this had resulted in patients 728 being kept waiting a long time in the outpatients' department. The Minister said at that time that senior nursing staff were on duty in the casualty department—presumably at all times—and if patients arrived needing urgent medical attention they could call medical staff from other parts of the hospital. One immediately wants to know why it was not done in the case of this baby. That is the first of several serious questions which need answering. I hope that the hon. Gentleman has the answers.
What senior nursing staff were on duty, and why was the sick child ignored, when it is common knowledge that a child's condition can deteriorate very rapidly? On whose judgment was the decision made not to call a doctor, and what were that person's qualifications which enabled her to take on the responsibility of not doing so? What steps have been taken since to ensure, at any rate, a reliable medical cover to the casualty department at all times, and to ensure that no one but a qualified medical person decides whether a patient should be admitted? What steps have been taken to remedy the obvious lack of communication between the casualty department and the chemists in the town? Does the hospital now have the chemists' rota available at all times, and would not it have been more appropriate for the hospital receptionist in those circumstances to have telephoned the chemist who was open, because this was an emergency?
This tragic case raises the whole question of emergency treatment in our hospitals. Many people have to turn to a hospital for emergency help, as this family did. In these days it is not possible to be absolutely certain that one's family doctor will turn out in an emergency, or that a partner will be available. Many people who travel away from home regularly—drivers, business representatives, actors, musicians, dancers, and even Members of Parliament—might be taken ill, and be unable to get a doctor. They would then obviously turn to the local hospital for help. Indeed, where else should they go? The Minister must satisfy himself that there is adequate casualty cover at every hospital in the country to decide whether sick persons should be admitted.
One cannot say that this baby would not have died, even in hospital; but one 729 can say that what chances he had were diminished because he was not admitted. That is why this is such a serious matter.
In my view, this case merits the fullest investigation in order to allay public concern. The hospital has been silent in the face of a great deal of publicity both in the national and local Press, and there is a good deal of criticism and unease about the whole affair. An impartial, thorough inquiry is the only satisfactory way of dealing with this case. Indeed, it provides a powerful argument in favour of a hospital ombudsman, and is exactly the kind of case which he should investigate.
Internal investigations by hospital management committees and regional hospital boards, where the hospital authority acts as judge and jury in its own cause, are becoming more and more debased. In the public interest, there must be some better method of investigating complaints, whether from patients, their relatives, or, indeed, from members of hospital staffs.
Whatever we do now cannot help these unhappy parents who lost their little boy, but we can and must make sure that such a thing never happens again.

§ Mr. J. Enoch Powell(Wolverhampton, South-West)
As the parents of this child resided, and as the hospital is situated, in my constituency, I have naturally applied my mind as best I can to the circumstances of the case.
I should like to put on record my conclusion that there is no ground for complaint against the services provided by the local executive council—in that I agree with the hon. Member for Wolverhampton, North-East (Mrs. Renée Short)—or against the hospital.
I say that about the hospital because the parents of the child arrived with the problem of finding a means of dispensing a prescription which had been made out for the patient by his family doctor, or by a locum of the family doctor. Therefore, there was no function for the hospital to perform and there was no reason why the hospital should secure a medical examination of the child, that not being in any case the purpose of the visit of the parents.
It is indeed unfortunate that the parents were unable, though the means existed 730 for doing so, to locate a chemist who could have dispensed the prescription. That, in my view, does not alter the fact that blame does not rest upon the hospital authority any more than on the local executive council and those in contract with them.

§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
First, I should like to express sympathy with the parents of the child, Ravinder Singh Dhadral, whose death occurred in such sad circumstances last Christmas.
I am glad that the hon. Member for Wolverhampton, North-East (Mrs. Renée Short) and my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) have found a brief opportunity to bring the case to the attention of the House. I had already promised to write to the hon. Lady following the inquest. I am sorry that I have not been able to do so before the Adjournment debate which she secured this evening.
I am aware that the hon. Lady has been concerned for some time about the medical staffing of the accident and emergency department at the Royal Hospital, Wolverhampton.
In the past year this department has had to work at times under considerable difficulties, in common with accident and emergency departments elsewhere, and in a recent letter to the hon. Member I set out the steps which are being taken on a national basis to improve the situation. We must improve the career opportunities and the scope for well-supervised training in these departments, and the establishment of about 30 new consultant posts will be a useful step forward and will help us to study the best pattern of staffing in these departments.
In the case of our particular concern tonight, however, shortage of medical staff was not a direct factor; there were at the time no vacancies on the medical staff establishment of the department, and a senior house officer was on duty when the child was brought into the accident and emergency department.
Before referring to the case in detail, I should make it clear that as the matter was inquired into by the coroner—this 731 relates to the hon. Lady's complaint—the hospital authority has decided that a further inquiry would serve no useful purpose. The details of the case as I shall relate them are, therefore, derived from the statements made at the inquest.
To get the record straight from all angles, I should first like to mention the events as related at the inquest which led to the child being brought to the accident and emergency department at the Royal Hospital. On 21st December, the baby, who then was about three months old, had a severe cold and cough, and early in the morning of 22nd December his father, Mr. Dadral, telephoned his doctor; the locum doctor who attended gave a prescription for the child which was dispensed by a chemist later that day.
As, despite the medicine, the child's condition did not improve, the father again called the doctor on Christmas Day; the locum doctor who had previously attended called about 6.30 in the evening, left a small supply of medicine and gave another prescription. After trying unsuccessfully to have this prescription dispensed on the afternoon of Sunday, 26th December, the father telephoned the locum doctor and was told by the person who answered the telephone that some chemist would have been open and that he would have to wait until the next morning. As he thought that the baby's condition had worsened, the father telephoned for a taxi, and the parents took the baby to the Royal Hospital, arriving there about 9.15 in the evening.
The story of what happened after that was told at the inquest by the various persons concerned—the father, the receptionist, the night superintendent and the doctor. Inevitably, each of these remembered certain happenings more clearly than others, and this was reflected in the statements they made. The hon. Member will not expect me to indulge in a comparative assessment of the variations in the evidence which are inevitable when events are seen from different angles. In relating what I understand to have occurred, I have endeavoured to extract the general picture. I do not think that the difference of emphasis in the statements made affects the general picture.
The father first approached the receptionist and asked her whether the hos- 732 pital could give him the medicine which had been prescribed. The night superintendent on duty looked at the prescription and told the father that the hospital pharmacy was closed. She also looked at the child, who was then asleep, and saw that he was not cyanosed or distressed but was breathing quietly. The night superintendent then gave the father the names and addresses of two chemists who lived on their shop premises and who she thought would dispense the prescription for him; she then left the department to attend to duties elsewhere.
Mr. Dadral tried to contact one of the chemists by telephone but was unsuccessful. He then telephoned for a taxi, and, while waiting for it to arrive, asked the receptionist whether a doctor would see the baby. The receptionist approached the doctor on duty, who suggested that the father should contact his own doctor again if he was unable to get the prescription dispensed by one of the chemists whose addresses he had been given. The taxi then arrived and the parents left the hospital with the baby.
Having passed on the doctor's advice to the father, the receptionist thought that when the parents left the department with the child they proposed to go in the taxi to one of the chemists whose addresses had been given and that if they were unsuccessful in having it dispensed they would go home and call their doctor again.
In fact, the parents took the child home, and, although the father then went to the road where his own doctor lived, he was unable to find his house and returned home without contacting him. The next morning, as the child appeared to be dead, the father called an ambulance and at the Royal Hospital was told that the child was dead.
One of the questions which has been asked is why a hospital doctor did not see the child. The standing rules for the accident and emergency department at the Royal Hospital made it clear that patients who are not accidents or emergencies should nevertheless be seen by the doctor on duty before being referred to their own doctor. In this case there was a misunderstanding on the part of the receptionist as to when the prescription had been issued. As a result, she informed the hospital doctor that the prescription had been given earlier 733 that same evening and that the doctor who gave it had been content that it should be dispensed the following morning.
The hospital doctor knew that the parents' first concern had been to obtain the medicine which had been prescribed. He accordingly acted in the belief that the child had been seen recently by a doctor and was not in need of urgent medical attention.
I know that some doubts have been raised about the adequacy of the pharmaceutical services inWolverhampton over the Christmas period, but I do not consider them to be justified by the facts. I am glad that the hon. Lady and my right hon. Friend acquitted the services of any shortcomings in this respect.
Under the executive council's hours of service scheme, prepared under Regulation 25(1) of the General Medical and Pharmaceutical Services Regulations, 1966, chemists may be required to participate in a rota under which one or more pharmacists open for an additional hour in the evenings, on weekdays and for an hour on Sundays and public holidays.
Under paragraph 4(2) of the chemists terms of service—Part I of Schedule 4 of the regulations of 1966 to which I have referred—notices giving such details are required to be exhibited in all pharmacies. Provision for a rota service was made by the Wolverhampton executive council, and notices were properly exhibited at the relevant times.
Over the three-day Christmas holiday four pharmacies were open from 12 p.m. to 1 p.m. and two chemists from 6p.m. to 7 p.m. on each day. Executive councils also reinforce these provisions by voluntary arrangements with chemists, and in Wolverhampton there were five pharmacists who were prepared, if available, to dispense at any time prescriptions marked "urgent" by the doctor, and their names were supplied by the executive council to the local police.
These arrangements are additional to the fundamental safeguard embodied in paragraph 7(9)(a) of the doctors' terms of service, Part I of Schedule I to the regulations, that theirs is the responsibility 734 for supplying patients with drugs before a supply can be otherwise obtained from a pharmacy.
I understand that the doctor who attended the child at 6.30 p.m. on Christmas Day left, as I have already mentioned, a small supply of medicine at the same time as issuing the prescription, which was not marked "urgent". There should have been at least two and probably three opportunities for getting the prescription dispensed by one of the six rota pharmacists, providing what I regard as a reasonable pharmaceutical service over the Christmas holiday period.
The question has also been raised whether the hospital staff should have ensured that the father was able to get the prescription dispensed. This would not normally be necessary, nor expected of hospital staff, although, subject to the pressure of normal duties, a helpful receptionist might take such action in the case of an "urgent" prescription.
Bearing in mind that this prescription did not carry an "urgent" endorsement and the receptionist might have been in some doubt whether this was a real emergency, her advice to the father to call the doctor again if he could not get the prescription dispensed was in the circumstances reasonable.
I do not think the hon. Lady will expect me to comment on matters of clinical judgment, nor would it be appropriate for me to suggest how the life of this child might have been saved. However, it is clear that there were misunderstandings and delays and that, despite the availability of facilities for the dispensing of prescriptions and for medical attention, tragically the baby did not receive the treatment he needed. This is a tragic case, and I am sure that all who have followed it must feel deep sympathy for the parents.
As the hon. Lady knows, the inquest verdict was death by natural causes, but that covers up what is a real and, I believe, in this case, avoidable tragedy.