Shay’s outcome ‘could have been different’ if treated sooner for infection, inquest told

Dr Leana Fernando, locum consultant in paediatric intensive care at Sheffield Children’s Hospital, gave evidence yesterday (Thursday) on the fourth day of an inquest into the death of Rawmarsh youngster Shay Turner (pictured). 

While Mr James Donnelly, paediatric consultant at Rotherham Hospital was caring for Shay in the High Dependancy Unit, he had called the Embrace team, a highly specialist, round-the-clock transport service for critically ill infants and children for assistance.

Dr Fernando was included in the telephone call made by Mr Donnelly in the early hours of March 31 last year about the “extremely sick” youngster.

Shay was showing serious signs of cerebral ischemia, which causes an insufficient flow of blood to the brain and Dr Fernando believed he seemed more like a child with septic shock and not diabetic, which was the current working diagnosis at that time.

“At this point, Shay was in a very bad state,” said Dr Fernando. 

“If it wasn’t for Shay’s given history that he had been drinking and urinating more, I would have leaned towards infection more as a primary diagnosis based on the symptoms he was showing.”

Shay’s mum Laura denies a claim by Rotherham Hospital paediatric registrar Dr Kiran Kumar that she had told him Shay had been drinking and urinating more.

A complication of Type 1 diabetes, DKA, remained as the diagnosis, but sepsis was still being considered. However, with DKA the amount of fluid a patient is given is limited, because if increased, it can make the condition worse.

Dr Fernando added: “It’s possible if more aggressive fluid management had be given sooner and treated for infection first, Shay’s outcome could have been different.”

Dr Neil Wright, consultant paediatric endocrinologist, was also included in the telephone call with Mr Donnelly and Dr Fernando.

He also suspected Shay had sepsis and not diabetes because his symptoms were not typical of DKA. 

Dr Wright said at this point the principal concern was keeping Shay ventilated. 

He said: “If there wasn’t any previous family history, I wouldn’t have dismissed DKA completely, but would have put more emphasis on sepsis. 

“I think he had shock when he was admitted to hospital and feel something in his bowel wasn’t right.”

Shay died in Sheffield Children’s Hospital on April 3.

Following his death, a serious incident investigation by Rotherham Hospital and Sheffield Children’s Hospital was launched.

Speaking about the report, Dr Callum Gardener, executive medical director of Rotherham Hospital NHS Foundation Trust, said a number of changes had been made at Rotherham Hospital since Shay’s death to make sure no other child is given an overdose of insulin.

Some of the changes include; electronic guardrails now being implemented on the amount of insulin a paediatric patient can receive to make sure an overdose can’t be administered; a similar equivalent being placed on electronic prescription systems which require two signatures from staff before medication is given out.

Dr Gardener also told the court extra focus had been placed on staff training and education, particularly around the signs, symptoms and guidelines of sepsis and diabetes. 

The hospital has also purchased Ketone meters, which weren’t available to take Shay’s ketone measurements when he was admitted. 

The inquest is expected to conclude on Monday afternoon (October 14).