Doctors cleared of manslaughterBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7177.148 (Published 16 January 1999) Cite this as: BMJ 1999;318:148
- Clare Dyer, legal correspondent
Two doctors from Great Ormond Street children's hospital in London were cleared last week of the manslaughter of a 12year old patient who was accidentally given the cytotoxic drug vincristine intrathecally instead of intravenously.
Dermot Murphy, a registrar in haematology, and John Lee, a specialist registrar in paediatric anaesthetics, were accused over the death of Richie William in July 1997.
The Crown Prosecution Service dropped the case after deciding that the death was the result of a catalogue of mishaps and failings in the hospital system rather than gross negligence by the doctors.
A key prosecution witness, Alan Aitkenhead, a professor of anaesthetics at Nottingham University, had changed his mind about Dr Lee's level of culpability and concluded that hospital failures had greater responsibility for the death than he had first thought.
Vincristine is fatal if given intrathecally, although the patient can be saved if a washout is done quickly. The error, which has happened at least 10times in British hospitals, arises because vincristine is given along with methotrexate, which is administered intrathecally.
Two junior doctors were convicted of manslaughter in 1991in a similar case, although their convictions were overturned on appeal. In another case in 1997the patient was left paralysed, and the Crown Prosecution Service is deciding whether to go ahead with charges against a doctor at St Bartholomew's Hospital in London after a similar incident.
Richie, who had non-Hodgkin's lymphoma, was apparently responding well to treatment when he went to the hospital for a last dose of chemotherapy. He should have fasted, but he had eaten a biscuit so the treatment had to be delayed. That meant that the senior registrar who was to have administered the treatment was off duty.
In addition, the cancer ward was full so he was sent to a general ward. A nurse on that ward, who was not aware of the hospital rule that vincristine should not be taken into the operating theatre, took both drugs into the theatre where Richie was to have his lumbar puncture.
The drugs were administered by Dr Lee, who had no experience of spinal injections of cytotoxic drugs. Dr Lee telephoned Dr Murphy and asked him whether the procedure was straightforward and whether he should just inject the drugs. Dr Murphy answered: “Yes.”
The hospital said that its systems had been tightened up after the tragedy.
Chief executive Robert Creighton said there would now be an inquiry.