Ryan Morse manslaughter trial: Doctors 'could have saved boy'

Dr Joanne Rudling (l) and Dr Lindsey Thomas

Two GPs accused of killing a 12-year-old boy could have saved his life if they had referred him for emergency treatment, a court has heard.

Ryan Morse, from Brynithel, Blaenau Gwent, died on 8 December 2012 from Addison's disease.

Prof Ieuan Hughes said this could have been prevented if a basic examination was done and he was sent to hospital.

Dr Joanne Rudling, 46, of Cardiff, and Dr Lindsey Thomas, 42, of Tredegar, deny manslaughter.

Prof Hughes, a consultant paediatrician, told Cardiff Crown Court he would have expected Ryan to survive, given emergency treatment, up until a few hours before his death.

And another medical expert, Dr Leonard Peter said the care both doctors gave Ryan fell far below expected standards.

Earlier, the court heard Ryan's mother twice phoned Abernant Surgery in Abertillery the day before he died.

On 7 December at 08:55 GMT, she spoke to Dr Thomas about Ryan's sickness and diarrhoea and said he was too weak to make it to the surgery.

Mrs Morse phoned the surgery again at 17:45 GMT and spoke to Dr Rudling after she noticed parts of his skin had turned "completely black" but was told it was hormonal changes due to puberty.

Prof Hughes said: "In my view, if Ryan had been admitted to hospital on the morning of 7 December and received satisfactory resuscitation, I would have expected him to survive."

He said he believed Ryan's life could also have been saved if he had been sent to hospital when Dr Rudling spoke to him and even up until 23:00.

He died shortly afterwards and Carol Morse woke at 04:15 GMT on 8 December to find him cold and lifeless on the sofa.

Ryan first fell ill in July 2012 and weighed just 4st 11lb (30kg) at the time of his death.

'Red flag'

Dr Peter told the court Dr Rudling should have weighed Ryan when she saw him on 7 November, a month before he died and on 21 November at a follow-up appointment, as Ryan's mother had mentioned his weight loss.

He said: "That complaint would have led any reasonably competent GP to weigh Ryan to see if he was below what was expected of a child of his age and height."

He said Dr Thomas had also missed several "red flag" symptoms when she spoke to Mrs Morse on the phone on 7 December and should have visited Ryan in person or arranged for him to be taken to A&E.

His symptoms included Ryan suffering from diarrhoea, being delirious and being unable to stand or walk.

He said: "Delirium in a 12 year old is not something I have ever experienced in 41 years as a GP except in a child with sepsis or meningitis- it's an extraordinarily unusual symptom.

"Taken together these symptoms should have given a strong warning for an overwhelming infection such as septicaemia or meningitis or metabolic problems like diabetes or indeed Addison's, although I would not have expected her to diagnose Addison's."

He said advising Ryan's mother to see how he was in a couple of hours was not appropriate as if he had had an infection, he could have fallen dangerously ill within that time.

The court heard an intravenous drip to rehydrate Ryan and boost his salt levels plus medication to raise his blood pressure could have saved him.

If his adrenal gland had been irreversibly damaged, he would have then needed oral medication for life, Prof Hughes added.

The trial continues.

Addison's disease

• Adrenal gland is damaged and not enough cortisol and aldosterone are produced

• About 8,400 people in the UK have it

• Symptoms include fatigue, muscle weakness, loss of appetite and unintentional weight loss

• People can also develop small areas of darkened skin or darkened lips or gums