Child turned blue before respiratory arrest, inquest hears

Doctors on Tuesday defended their treatment of six-year-old Aibha Conroy, who died four days after being admitted to University Hospital Galway suffering from hypoglycaemia, or low blood sugar, and weakness.

Kathleen and John Conroy, from Gowla, Connemara, Co Galway, accompanied by their daughter – Aibha's younger sister – were in attendance at the Coroner's Court in Dublin.

Ms Conroy asserts, through her solicitor Damien Tansey, that she was fully expecting a referral for Aibha to Crumlin hospital for further tests, shortly after August 24th, 2011, the results of which could have changed the tragic outcome for her daughter, she argues.

Through Mr Tansey, the inquest learned that the family questions the dosage of dextrose – which is key is treating hypoglycaemia – given to Aibha upon her admittance to University Hospital Galway in the early morning of December 11th, 2011. This discrepancy, and the possibility that Aibha was given the wrong dose, is “troubling” to her family, according to Mr Tansey.

Aibha died at Temple Street children’s hospital in Dublin on December 14th, 2011. Four days previously, she had been admitted to University Hospital Galway suffering from hypoglycaemia, or low blood sugar, and weakness.

The cause of Aibha's respiratory arrest at 2.10am on December 11th – just an hour and a half after she was admitted in Galway – remains unclear. According to Aisling Hillock, who was working as the paediatric senior house officer on call in Galway that night, Aibha was responding well to treatment and that her blood sugar levels were brought back to appropriate levels.

Dr Hillock told the inquest that Aibha arrived at the hospital at approximately 12.45am. Aibha appeared to be sluggish, and needed to be supported by her mother when standing. At the time of admittance, Aibha’s blood sugar levels were at 1.3, which is quite low.

She was given an infusion with 5 per cent dextrose, in the hope of raising her blood sugar. Dr Hillock said that, by 1.10am, Aibha’s blood sugar levels had improved to 2.4, and that she was sitting up in bed and talking to her parents.

At 2am, Aibha’s blood sugar levels were at 4.8, but she vomited and started to complain of headaches. Her oxygen saturation quickly decreased and she turned blue. She then went into respiratory arrest.

Aibha’s parents dispute the idea that their daughter was responding well to the dextrose. They argue that she was sluggish throughout the entire time before her arrest.

Turning blue

They also argue that Ms Conroy had to alert Dr Hillock to the fact that Aibha was turning blue right before her arrest. Dr Hillock emphatically disagreed with this – she said she did not need to be told that Aibha was turning blue, as she was looking at the young girl and could see for herself.

Unlike many of the witnesses who gave evidence on Monday, Dr Hillock remembers Aibha and her parents. She remembers Aibha in part because Aibha was the first child whom she had seen arrest. Aibha was also the first child whom Dr Hillock had treated for hypoglycaemia, although she had previously treated adults.

Dr Hillock told the inquiry that, as she had never treated a child with hypoglycaemia before, she consulted her registrar about the appropriate dose for Aibha, adding that it would be common practice to consult with her senior colleague on such matters.

Dr Ngi Chiw Teo also gave evidence. As the registrar in paediatrics at University Hospital Galway on December 11th he was the most senior doctor on the premises that night (although there was a consultant on call).

Dr Teo said he did not recall the patient, although he meant no disrespect to the parents by this. He also said he did not provide direct care to Aibha but provided advice to Dr Hillock, who informed him about Aibha “because she’s such a competent SHO”.

Dr Teo said that when Dr Hillock consulted him regarding the dosage of dextrose that she was planning to give to Aibha, he concurred with her.

Dr Teo said he did not recall seeing Aibha that night, although “I must have”, he said, adding, “I had confidence in Dr Hillock’s assessment”.

Dr Vladimir Alexiev, who was part of the resuscitation team, said he made it to Aibha within two minutes of receiving the call about her respiratory arrest. At that point he took over ventilation.

Once Aibha was ventilated, he spoke with his colleagues about her history. He told the inquest that he was informed by his colleagues that Aibha’s blood sugar right before the arrest was normal.

Dr Alexiev then accompanied Aibha to get a CT scan. He said that, while on the way to the scan, Aibha’s pupils were dilated and were fixed or sluggishly reacting.

On foot of the CT scan, Dr Alexiev and his colleagues discussed a transfer to Temple Street children’s hospital, which took place later that day.

As the proceedings drew to a close, Catherine Corbett Sheridan, a nurse at the Galway hospital, gave evidence. She said that she came on duty on August 24th, 2011, the day that Aibha was discharged from one of her visits, and spoke with Ms Conroy that day.

Ms Sheridan knows the Conroy family, as she grew up near Ms Conroy. She attended Aibha’s wake and paid her respects to Ms Conroy there.

During his questioning, Mr Tansey told the inquest that Ms Conroy says that she was told on August 24th that Aibha needed further tests in Crumlin. Ms Conroy has said that, at Aibha’s wake, Ms Sheridan asked her whether Aibha ever got the referral to Dublin.

Although Ms Sheridan said she remembered being at the wake and paying her respects to Ms Conroy, she told the inquest she could not recall the content of that conversation. “I cannot recall the specifics of any conversation from four years ago,” she said.