Co Down boy Stephen McElroy (11) died because A&E doctors missed diagnosis, coroner
An 11-year-old boy who died from a rare bowel condition hours after a doctor misdiagnosed him would still be alive today if his symptoms had been correctly investigated, an inquest has heard.
Stephen McElroy collapsed and died in Daisy Hill emergency department from a bowel obstruction in March 2015 some six hours after being discharged.
The Southern Health Trust admitted during the inquest into his death that there were a number of missed opportunities to correctly diagnose him.
His mother Patricia, from Ballyward, told Armagh court yesterday that Stephen had been treated for appendicitis in 2012 and had suffered a bowel obstruction and adhesions following this.
Then on March 28, 2015, her "big and strong" son started complaining of having a pain in his right side, was feeling nauseous and vomiting for most of the day. Mrs McElroy rushed her son to the accident and emergency department at around midnight, where he was triaged by senior nurse Maria Hughes.
After being made aware of his medical history, Stephen was categorised as 'priority three', which means he should have been seen by a doctor within one hour. But it was a further six hours before he was assessed by Dr Aine Mullen.
During those crucial hours Stephen's health continued to deteriorate and while he made numerous attempts to go to the toilet he had no bowel movements.
At around 6am Dr Mullen misdiagnosed him as having constipation, and he was discharged with medication to help his condition.
Some hours later Stephen took two tablets but vomited them up 10 minutes later. A concerned Mrs McElory rang the hospital and spoke to Dr Mullen who said to give it to him again later and to allow him to rest, but was not advised to return to the hospital.
But within an hour his condition worsened and his parents rushed him back to A&E.
His dad Paul held hands with Mrs McElroy as she gave evidence about the hours leading up to Stephen's death.
Dr Mullen told the court that at the time of Stephen's death she had GP training for two years and had a year's experience working in an emergency department.
Wiping tears from her face, Dr Mullen said she was aware he had previous bowel adhesions.
The court heard that symptoms of bowel obstruction include failure to have bowel movements, vomiting and abdominal pain - all of which Stephen had.
Defending her diagnosis, Dr Mullen said: "Clinically, in front of me was a comfortable child, I did not feel I had to carry out any abdominal examination."
She agreed with the coroner's counsel that a number of bowel obstruction features were there and that it was something she had "considered as a possibility".
When prompted by the family's solicitor Paddy Mularkey, she admitted that it was a "missed diagnosis".
She further admitted that she knew at the time that vomiting was not a feature of constipation, whereas it was in bowel obstruction cases.
Independent reports carried out by Dr Philip O'Connor and Professor Patrick Plunkett stated that a blood test or an X-ray should have been carried out.
Professor Plunkett said the six-hour wait for an assessment was an "inordinate long time" for a young boy. He told the court that the correct diagnosis should have been made because all the symptoms were there, particularly because of his previous medical history. Prof Plunkett added: "I think these dots were there to be joined."
Both medics agreed that Mrs McElroy should have been told to return immediately when she rang the hospital after Stephen was discharged.
Prof Plunkett added that if a senior doctor had been present a different diagnosis would have been made.
Dr Paul McGarry, who is based at Craigavon Hospital, said that a number of protocols have now been put in place.
These include that all blood tests are carried out on children who present at the hospital with abdominal pain. He also said there are problems with recruiting staff at the hospital, which is "putting patients at risk".
In his findings, coroner Joe McCrisken said that the care provided to Stephen was "wholly inadequate".
He said there was a failure to meet his triage target and to properly diagnose him with the "sufficient" symptoms or to explore the complications further.
He said that Dr Mullen did not properly consider his condition nor carry out the relevant tests.
He also said Prof Plunkett stated that had he been properly assessed and treated, he most likely would have survived.
After the inquest, Mrs McElroy said she hoped no other family will have to go through the same.
"There were a lot of mistakes made on the part of the Southern Trust," she said.
His dad Paul added: "We hope that in the future people learn by Stephen's death, for other children."