A ten-year-old girl was killed by a nurse who botched the insertion of a feeding tube and then ignored danger signs in defiance of national guidelines, a court heard.
Tragic Phoebe Willis screamed in pain and started bleeding when Carrie Anne Nash pushed the tube in despite feeling something blocking its way, a jury was told.
Nash, 34, a paediatric specialist, then ignored a series of ‘red flag’ indicators and sent the youngster home, it was heard.
But when Phoebe’s mum, Heather Willis, fed her milk before putting her to bed that night it seeped into the cavity between her vital organs which eventually resulted in blood poisoning.
The next morning Heather dialled 999 after finding Phoebe “looking grey” but by the time the ambulance arrived her lips were blue and she had gone into cardiac arrest.
Phoebe died the following evening after further cardiac arrests and brain injury and Nash was charged with her manslaughter three years later.
Bristol Crown Court heard that the youngster needed a feeding tube because she suffered from cystinosis, a rare genetic condition.
Since her diagnosis as a baby the tube was changed every three months – a simple procedure which her parents Julian and Heather had been used to carrying out.
But they decided to take Phoebe to Weston General Hospital, North Somerset, after they found it unusually difficult to push a new tube in, in August 2012, it was heard.
None of the medics on shift were qualified to deal with the situation so Nash, a community nurse employed by Nutricia Ltd., was called in to help.
Prosecuting, Sarah Whitehouse QC, said Nash “repeatedly attempted” to insert the device, known as a mini balloon button.
She said: “When she finally succeeded, she didn’t make sure the tube attached to the button was where it should be – extending from the abdominal wall and into the stomach.
“She ignored what are called ‘red flag’ indicators which would have warned her that the tube was not in Phoebe’s stomach.
“Tragically, the tube wasn’t properly placed and so when Phoebe was fed through the tube, milk did not enter her stomach but rested in the cavity between her organs.”
This caused infection, sepsis and, ultimately, the little girl’s death, the court heard.
Ms Whitehouse added: “This is how Ms Nash came to be charged with manslaughter.
“Not because she intended to kill Phoebe, or wanted Phoebe to die or be harmed in any way.
“But because she acted contrary to national guidance, contrary to her employer’s safety protocols and contrary to her training.
“Critically, she failed to recognise or act on ‘red flag’ indicators that suggested there was a serious problem with the tube placement.
“She provided a level of care to Phoebe that was so very far below the standard to be expected of a nurse with her specialist training that it can properly be described as criminal.”
The jury was told that after inserting an button, there was a two-hour window in which replacement tubes can be fitted before the tract closes up.
Phoebe’s mum removed the existing tube at around 11.05am and Nash arrived at the hospital at 1.05pm – just inside the time frame, the court heard.
After inserting the tube – which Heather said Nash did with some force – Phoebe started bleeding and was in pain – both “red flags” indicating a problem, it was heard.
The nurse then took a liquid sample through the tube to check it was acidic, as it would be if it was properly inserted into the stomach, and found the pH was six.
That should also have caused concern, as national guidelines suggest that any pH above five and a half is not acidic enough and indicates that the tube isn’t in properly.
Nash claimed she told a hospital doctor who didn’t seem worried but he said “if he had known about this factor it would have caused him concern”, the court heard.
The nurse, who qualified in 2003, then flushed the tube with water – causing Phoebe to cry out and complain of chest pain – before discharging her from hospital.
In doing so, she ignored important ‘red flags’ including persistent pain and fresh bleeding around the site, which should have seen Phoebe admitted to hospital.
That night, the poorly youngster was fed some milk through her tube and watched a DVD before going to sleep at home in Locking, North Somerset.
She was rushed to hospital the following morning, where medics battled to save her, the court heard.
Sadly, Phoebe died the next day, at 9.55pm on Sunday, August 26 2012, after she stopped breathing for 40 minutes and her intensive care was eventually terminated.
A post-mortem showed she died of brain injury as a result of “overwhelming” sepsis – blood poisoning – caused by milk peritonitis, which was triggered by the tube change.
Nash, of Portishead, North Somerset, denies manslaughter and the trial continues.