A five-year-old girl with a rare blood disorder suffered a heart attack and died after two doctors failed to spot the infection ravaging her body, a hearing was told today.
Gerald Hanson and Nivedita Bajaj could have saved the youngster by transferring her to the intensive care unit at St Mary's Hospital, Paddington, the General Medical Council heard.
But paediatric consultant Hanson kept her in a cubicle at the Central Middlesex Hospital, north London, as 'he did not consider that the patient was sufficiently unwell', it is claimed.
Just hours later the girl's organs shut down and she died following a cardiac arrest on March 18, 2007.
Now Hanson and his paediatric registrar Bajaj face a series of allegations in relation to their care. If they are found guilty they face being struck off the medical register.
Peter Atherton, for the GMC, said: 'It is accepted that Dr Hanson did not consult paediatric intensivists has to the possibility of transfer of the patient.
'Dr Hanson stated in a letter of response to the GMC that he didn't consider contacting CATS, [Children's Acute Transfer Service] or requesting referral to the paediatric intensive care unit because he didn't consider that the patient was sufficiently unwell to warrant a transfer.
'He said that he felt it was appropriate to monitor her condition and await the results of blood tests.'
Hanson then wrote to the child's GP stating the cardiac arrest was 'sudden and unexpected'.
The GMC will call a raft of experts to contradict his opinion, the hearing was told.
Mr Atherton said: 'The GMC's submission is that in the absence of timely treatment, the consequences in this case were predictable.
'The patient's oxygen requirement and respiratory stress increased and her blood pressure had fallen due to rapid advanced septicaemia in an immune compromised patient.'
The girl, who has not been named, was admitted on Friday night, March 17, to the Acton Lane hospital but was sent home on Saturday morning.
That evening she collapsed at home and was rushed to their emergency department where she was put under the care of Bajaj and consultant Hanson.
Despite admission at 8.30pm, Bajaj did not contact the child's own doctor at St Mary's Hospital where she was being treated for a rare blood disorder known as diamond blackfan anaemia until 11pm.
Dr Sarah Mangles advised the registrar to start the patient on a combination of drugs including antibiotics. But the medication was not administered until 5am, it is alleged.
The GMC heard Bajaj 'took insufficient action' between 3am and 5am to treat the patient and prevent her infection from worsening.
At 3am, the registrar contacted her superior, Hanson, who allegedly also told her to start the drugs.
But his advice to Bajaj 'was not sufficiently clear and specific', the GMC was told.
By at least 4am the child had deteriorated and was suffering 'advanced septicaemia and clinical shock', it is said.
At 7am, Hanson wrote out a plan of action that involved waiting for blood tests.
It did not include frequent monitoring of her condition or regular observations, it is alleged.
Mr Atherton added: 'Now the GMC submission is that if at 3am Dr Hanson advised Dr Bajaj to start tazocin or gentamicin at the reduced dose appropriate to renal disease as he has stated in his response [to us], she clearly did not do so.
'It seems that she believed that his advice was to await the second blood results, and so it is that the GMC alleges that Dr Hanson's advice to Dr Bajaj was not sufficiently clear and specific as to the actions she should take.
'We submit that if Dr Bajaj had been managing the patient properly, she would have examined her and found clinical evidence of poor circulation about which Dr Hanson should have been informed.
'Sometime around 4am when this deterioration was manifest, the patient's father called his wife who with her sister travelled to the hospital, arriving around 6am.
'She immediately saw the deterioration and the child was telling her that she had pain.
'At this stage she was still in the cubicle and her mother was concerned that she had not either been moved to St Mary's Hospital or to an intensive care unit.'
She had a cardiac arrest just hours later, in the morning of March 18, 2007. She died from multiple organ system failure and shock after an infection similar to meningitis took hold.
Hanson and Bajaj are both attending their joint hearing in central London.
Hanson has admitted that he did not consult a paediatric intensivist for advice about her management or transfer and he admits this was not in the patient's best interests.
But he denies failing to give Bajaj clear and specific advice and failing to issue a management plan which included frequent checks and medical reviews.
Bajaj had admitted several failings in record keeping of the patient's condition.
She denies that Dr Mangles or Dr Hanson advised her to start medication. She admits the drugs were not started until after 4am.
She further denies she failed to take sufficient action to manage the patient. The hearing continues.
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