Boy died after nurse's 'stark' error, court hears

Jurors were told that James Dwerryhouse, seven, from Ipswich, was a "happy, lively" child

A boy died when it went undetected that he had stopped breathing because a senior nurse failed to connect him to monitors while he was in intensive care at a private children's hospital, a court has heard.

It is alleged Anuradha Bhupathiraju made a "stark and fatal error" which led to James Dwerryhouse's death while she was the nurse in charge of the paediatric intensive care unit (PICU) at the Portland Hospital, central London, in August 2016.

The nurse, 64, who denies manslaughter by gross negligence, is on trial at Southwark Crown Court.

James, seven, from Ipswich, had a number of "significant" health conditions, including sleep apnoea, which made him prone to stop breathing while sleeping.

On August 25, 2016, he underwent routine bowel surgery at the private hospital which went well, the court heard.

He stayed in the Portland's PICU overnight so he could be closely monitored because of the risk that he might stop breathing in his sleep.

Ms Bhupathiraju was the nurse in charge of the PICU that night and took over personal care of James twice during her shift when a junior nurse was taking breaks, the jury heard.

The second time the defendant took over, at 02:10 BST on August 26, James was awake and had just had his monitoring equipment "temporarily removed" by the junior nurse because he had been distressed and was pulling at the wires, the court was told.

Cardiac arrest

James fell back asleep about 40 minutes after Ms Bhupathiraju took over his care, prosecutor Andrew Thomas KC said.

"Once James had fallen back asleep, the defendant should have resumed the electronic monitoring.

"The need for monitoring was the central reason why he had been admitted to intensive care in the first place," said Mr Thomas.

"The risk that he might stop breathing and go into cardiac arrest was the very risk that the doctors were guarding against.

"But the defendant did not do that. For over an hour, she left James to sleep in the bed without resuming the monitoring. It was a stark and fatal error."

The junior nurse came back from his break just before 04:00 BST and resumed care of James, the court heard.

Mr Thomas told jurors: "He found that the monitors had not been reattached and he went about connecting them up himself.

"He switched the machines on but there was no signal. He assumed there must be a fault with the machines.

"After several attempts, he realised to his horror that the problem was not that the monitors were not working but that James's breathing and heart function had both stopped. No breaths. No pulse."

CPR was started and staff managed to re-establish a pulse, but because he had been "starved" of oxygen James suffered a "serious and irreversible brain injury".

Tests showed the injury was not survivable, and after consultation with his family James was discharged to a hospice in Ipswich, near his home, where he died the next day.

"James's death was wholly preventable," the prosecutor said.

"James died because Anuradha Bhupathiraju failed to carry out that vital monitoring.

"If she had properly carried out the basic job of monitoring James's condition, she would have known that he had stopped breathing, she would have been able to intervene, and he would have survived.

"Put bluntly, her very serious neglect caused James's death."

The court heard the defendant admits that she did not reconnect the monitors, but claims she had been given only "limited information" about James's conditions and did not realise the serious risk he was in.

Ms Bhupathiraju works at the Royal Brompton Hospital and has had 40 years of experience as a nurse, including more than 20 years of experience in UK hospitals, jurors heard.

At the Royal Brompton, the defendant became a grade seven nurse and the deputy matron on the paediatric and paediatric intensive care wards.

She also took additional shifts in the private sector and regularly worked at the Portland, acting as nurse in charge.

The trial continues.