Hyponatraemia inquiry: Death certificate timing 'very irregular'

The hyponatraemia inquiry is hearing evidence at Banbridge courthouse

The timing of a death certificate for a child who died in a Belfast hospital was "very irregular", a public inquiry has heard.

The comments were made as the inquiry into the deaths of five children in Northern Ireland hospitals resumed in Banbridge.

The court is hearing evidence regarding the case of Lucy Crawford.

The two-year-old died after being treated in the Erne Hospital in Enniskillen in 2000.

The inquiry is not investigating the circumstances of Lucy's death but to what extent there was a failure to learn lessons from her death.

It is also reviewing whether that impacted on the death of another child 14 months later.

In her opening remarks on Tuesday, the senior counsel for the inquiry told the court that an expert witness had described as "very irregular" that Lucy's death certificate should follow much later than her autopsy.

The court also heard about the "lack of effective communication" at all levels and the "absence of professional inquisition" about how a healthy child could die from gastrointeritis.

Lucy Crawford was the youngest of three children.

She was admitted to the Erne hospital on 12 April feeling lethargic.

She died two days later in the Royal Hospital for Sick Children in Belfast.

In 2008, her parents asked for personal reasons that her death be removed from the inquiry.

While that wish was respected, the inquiry's chairman said the issues raised by her death remained vital to the wider community.

Among the issues being examined is how the cause of Lucy's death was established and agreed by clinicians.

This inquiry is examining the clinical, hospital management and trust governance issues arising from the two-year-old's death.

The inquiry is particularly concerned to examine why the contribution played by hyponatraemia in causing her death was not recognised and acted upon at the time.

While Lucy was initially admitted to the Erne Hospital, she was later transferred to the Royal Belfast Hospital for Sick Children (RBHSC).

In relation to her care in Belfast the inquiry is examining:

• The steps taken by the RBHSC to investigate the circumstances leading to Lucy's death and to ascertain its causes, and the outcome of those steps

• How the cause of Lucy's death was established and agreed, including how and when the clinicians responsible for Lucy's treatment discussed and agreed on a cause of death

• The extent and quality of the information conveyed to the coroner's office about the circumstances of Lucy's death and whether it complied with any governing guidelines, procedures and practices

• The reasons why it was decided that a coroner's post-mortem was not required for Lucy and why a hospital post-mortem was carried out.

The inquiry is examining the deaths of Adam Strain, aged four, Raychel Ferguson and Claire Roberts, nine, and it is also investigating the events following the deaths of Lucy Crawford, aged 17 months, and specific issues around the treatment of 15-year-old Conor Mitchell.

It is examining the fluid levels administered before their deaths.

In the case of four of the children, an inquest stated that hyponatraemia was a factor that contributed to their deaths.

Hyponatraemia is the term for a low level of sodium in the blood stream causing the brain cells to swell with too much water.