Paediatrician 'did not investigate medical history of boy with asthma'

A hospital paediatrician in the UK who treated a nine-year-old chess champion days before he died from chronic asthma failed to investigate his full medical history, an inquest has heard.

Michael Uriely was taken to the Royal Free Hospital in London twice in August 2015 after he suffered violent coughing and vomiting fits which left him struggling to breathe.

Dr Sherine Dewlett treated him on August 19, the second time his frantic parents, Ayelet and Roy, had taken him to A&E in 24 hours.

She had no idea that Michael had also been in the day before and did not properly read his medical notes, Westminster Coroner's Court heard on Thursday.

"My impression was he had only just come in for one day - I didn't have notes from the 18th," she added.

Dr Dewlett said she discussed Michael's history with his mother but failed to discover that he had been to A&E the day before or get full details of a previous visit in January.

She also had no idea he had been taking steroids for seven days, the inquest heard.

"I thought he had only just come in and been started on steroids that day, she added.

Coroner Dr Shirley Radcliffe said there was "no appreciation of the duration of the symptoms" and also questioned why no peak flow breathing tests had been carried out.

She added: "Here is a mother, undoubtedly anxious, undoubtedly worried, has had to go to the A&E department on the 18th and then come back to the A&E in the early hours of the morning.

"She's got two young twins at home - people don't do that unless they're really worried.

"It's a really anxious situation, yet you don't seem to have considered everything in any great detail."

Dr Dewlett replied: "I don't think I appreciated the level of concern."

When asked why she did not have Michael's full medical notes, she said: "The notes weren't printed out and I don't think they had been scanned on the computer yet."

Dr Dewlett later admitted that there were references to the earlier visit in his paperwork.

"If I had properly looked I would have realised that (he had come in before)," she added.

She continued: "When I looked at the notes after his death I was really upset - I realised he had been in on the 18th."

The coroner said: "Alarm bells should have been ringing in A&E if a child attends twice in 24 hours from the same condition - I would hope so and expect so."

She added that there was a "totally inadequate history-taking" to properly assess his long-term condition.

Michael, from St John's Wood, north-west London, died on August 25 2015 after suffering a chronic asthma attack.

He was also seen by NHS GPs, as well as having private doctor appointments, in the months before he died.

Expert respiratory pediatrician Dr Richard Iles said his death was preventable and he should have been referred to a specialist.

He told the inquest that the repeated courses of steroids and acute attacks were all signs that his care programme was not working.

"High doses of steroids should set an alarm ringing in people's ears - this child needed steroids to stay well."

He added: "This child had a long-term condition - it was managed as an acute event."

The Royal Free Hospital carried out two internal investigations after Michael's death and concluded that staff failed to diagnose him with chronic asthma and the care he was given was not adequate.

The hospital has since appointed two specialist respiratory clinicians, opened a dedicated asthma clinic and implemented a new strategy for treating children with asthma.

Dr Radcliffe indicated that she will deliver her verdict on Thursday afternoon and is likely to make a regulation 28 report which aims to prevent future deaths.

Seven other children in London have died from asthma since Michael's death in 2015, the inquest was told.