GP denies row clouded judgement

Robbie Powell died hours after being admitted to hospital

A GP who examined a boy hours before he died of a treatable illness has denied her judgement was clouded because she was arguing with his parents.

Dr Nicola Flower was giving evidence at the inquest into the death of Robbie Powell, from Ystradgynlais, south Wales.

Robbie, 10, died from the glandular condition Addison's disease in 1990 - on the day Dr Flower saw him twice.

She dismissed claims that she had only referred him to hospital because his parents were troublesome.

The inquest at Swansea Guildhall heard earlier on Wednesday how Dr Flower had visited the schoolboy twice on 17 April.

I took on board what they said and took my decision accordingly - I took my decision based on the information available to me Dr Nicola Flower

She had said that she had initially concluded that there was nothing seriously wrong with him but had changed her mind after being called out for a second time by his parents, William and Dianne Powell.

Dr Flower - who in 1990 had then been a GP for only eight months - told the inquest that the Powells had been "agitated" and insisted Robbie be referred to hospital.

'Clinical judgement'

Mrs Powell was represented at the inquest by Dr Michael Powers QC.

He questioned Dr Flower about why she had not spotted symptoms which less than an hour later a hospital doctor described as making Robbie look like "a concentration camp victim".

Dr Powers suggested to her that she had been determined that she was "not going to be told by other people what to do".

He said to Dr Flower: "Your judgment was clouded by your insistence that you should decide what should be done.

"But when you were called back the only way you were going to get rid of the trouble of these parents was to admit him to hospital."

Dr Flower said: "No. I took on board what they said and took my decision accordingly. I took my decision based on the information available to me.

"I took my decision based on my clinical judgment."

Referral letter

Dr Powers read out a statement by a Dr Vas Falcao, who had previously told the inquest he had been "taken aback" by Robbie's condition when he arrived at Morriston Hospital.

He said that staff at the hospital had described the boy's pupils as dilated, saying he had a gaunt appearance and his teeth were bared.

Dr Flower replied: "He did not look like that when I saw him.

"He did not have sunken eyes or an appearance of facial dehydration."

But child specialist Professor Ieuan Hughes told the inquest the care given to Robbie "fell below the standard I would expect."

Mr Hughes, who is head of paediatrics at Cambridge University, said he had difficulty in reconciling Dr Flower's account of Robbie's condition at 1530 BST on 17 April and the state which he was in at 1900 BST when he arrived at Morriston Hospital.

He said it was "probable" that had Robbie been sent to hospital at 1530 BST he would have survived.

'Discrepancy'

Professor Hughes said Robbie could have been saved by being placed on a saline drip had his condition been appreciated at 1530 BST.

He describe the lapse in Dr Flower's care as "serious."

He said there was a discrepancy which he could not resolve between Dr Flower's 1530 BST description of Robbie's symptoms and the 10-year-old's condition less than four hours later.

William Powell told the inquest his son was already in a collapsed state when Dr Flower examined him at 1530 BST.

Dr Flower insisted that Robbie was standing during her examination.

Critical of care

Professor Hughes said he found this "neither possible nor probable" bearing in mind Robbie's condition shortly afterwards.

Previously, the inquest has been told that Robbie was seen seven times by five separate GPs in the two weeks before he died.

It has also heard from another GP who denied dictating a letter of referral after Robbie's death.

But Dr Michael Williams did agree with a lawyer for the Powell family that there were inconsistencies with medical notes.

The Powells have criticised the level of care their son received in the weeks before his death.

The inquest continues on Thursday.