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overnight on 31 December 2015, and that he was two minutes away.
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RN Adams stated that
at no time on 1 January 2016 did she consider it necessary to call the doctor, as Naomi was
“clinically well.” She stated that the fact that this was New Year’s Eve made no difference to
whether she would call the doctor at home.
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MW Brewis said that she also did not think she
needed to call the doctor when attending to Naomi on 1 January 2016.
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She denied that it
would have been a matter of any inconvenience to call a doctor in the middle of the night.
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188. The court was assisted by the expert evidence of two emergency doctors, Dr Tyler and
Associate Professor Greenberg. They gave useful concurrent evidence, having had the
opportunity to review all the medical records.
189. The expert Emergency Physicians were taken to the vital signs recorded on the SMOC at
00:20 hours.
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They were asked what features of those vital signs would each consider to be
concerning or reassuring for the presence or absence of a more serious illness. Dr Tyler said
that, “Naomi was afebrile and her respiratory rate of 18 was in the normal range and was
reassuring”. The heart rate of 120, she considered abnormal, “too fast”.
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The blood pressure
she considered too low. In those circumstances, Dr Tyler would expect an extended
observation after those vital signs have been obtained and she would expect a medical officer
review. Associate Professor Greenberg agreed that the pulse was high at 120 and the blood
pressure was “on the low side”.
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190. In light of the history that RN Adams recorded, containing the note, inter alia, of
“generalised aches and pain”, Dr Tyler did not consider that to change her opinion. She said
the pulse rate was very high and “stands on its own”.
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Whilst she accepted that RN Adams’
clinical observation, “looks well” is a very important part of the assessment, she added that
people could look well and be very sick. Associate Professor Greenberg did not agree with the
opinion about the vital signs standing alone, but rather said that, “the worry is persistent
tachycardia”, if it stays persistently high. He agreed that, “120 bpm was of concern but what is
important is it comes down or not”.
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191. The experts were taken to the next set of observations, taken at 00:35 hours. Associate
Professor Greenberg said that the blood pressure was still a little low but that could be
explained by the pregnancy. Dr Tyler agreed that the heart rate going from 120 to 105 was
reassuring, but not sufficient. She thought the blood pressure remained low. She added that it
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Transcript 18/9/18, page 117, line 38
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Transcript, 18/9/18, page 117, lines 40-45
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Transcript 13/3/19, page 78, line 46 onwards
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Transcript 13/3/19, page 79,line 14
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