AN inquiry into the deaths of five children in the North of Ireland’s hospitals has found that four of them, including that of Derry girl Raychel Ferguson, were avoidable.
The 14-year inquiry into hyponatraemia-related deaths was set up to examine the deaths of the children.
Hyponatraemia is a medical condition that occurs when there is a shortage of sodium in the bloodstream.
The inquiry’s chair was scathing about how medical professionals had treated the children’s families.
Mr Justice O’Hara was also heavily critical of how some witnesses treated the inquiry, as they “had to have the truth dragged of them”.
He found that the health service was “largely self-regulating and unmonitored”.
The chairman said that the deaths of Raychel Ferguson from Derry, Adam Strain and Claire Roberts were the result of “negligent care”.
The inquiry also looked at the aftermath of Lucy Crawford’s death and concluded that her parents “were not told the truth” about what happened.
Mr Justice O’Hara also found that guidance issued in the aftermath of Raychel’s death “wasn’t followed” in the death of Conor Mitchell in 2003.
In total, the inquiry made 96 recommendations including the establishment of a duty of candour on medical professionals “that would impose a duty to tell patients and their families about major failures in care and to give a full and honest explanation”.
Mr Justice O’Hara said that the “reticence of some clinicians and healthcare professionals to concede error or identify underperformance or colleagues was frustrating and depressing”.
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