PEH missed injuries

HEALTH and Social Services yesterday refused to discuss how staff initially failed to spot manslaughter victim Elizabeth Roussel's broken ribs which punctured her lung. The 41-year-old mother-of-two died in the Princess Elizabeth Hospital three days after a vicious attack by two women in Town in June.

Joanne Baker, 20, and Layla Germain, 17, were each jailed for five years by the Royal Court on Thursday after admitting her unlawful killing.

Mrs Roussel was x-rayed the day after she was admitted to hospital on Saturday 25 June. Examination of the film then detected no fractures to the rib cage.

But the next day, chest x-rays were taken and she was given a CT scan. An x-ray showed fractures to two of her ribs. The film from the previous day was reviewed and a fracture to the ninth was just visible.

The Guernsey Press asked Health and Social Services whether it believed that the treatment Mrs Roussel received was adequate and if later complications and her death could have been avoided.

It said it was aware of the circumstances of her case. 'However, it is not our policy to comment publicly on the care provided to individual patients,' it said.

During the case, defence lawyer Advocate Catherine Fooks argued that a Home Office pathologist had suggested that ordinarily the victim of such a prolonged attack would not have died from her injuries. But by the time anyone realised she had a serious infection, the fracture of the ribs had displaced and it was too late, she said.

This view was supported by Advocate Nick Barnes, also defending.

HM Procureur Nik Van Leuven had indicated that the defence might make criticism of the medical treatment that Mrs Roussel received following her admission to hospital.

'What is clear from the expert evidence is that the existence of the fractured ribs was by no means immediately evident from the first x-rays that were taken. The Crown would not wish to comment on the quality of the treatment that Mrs Roussel thereafter received in hospital,' he said.

'It is not for the Crown either to defend or criticise the medical authorities for the quality of treatment.'

Subsequent microscopy samples taken at the autopsy were consistent with the rib fracture having been sustained around the time of the assault.

Sets of x-rays were submitted for forensic examination by Professor Adrian Dixon, professor of radiology at the University of Cambridge School of Clinical Medicine.

When reviewing the x-rays taken on 25 June, he concluded that it was just possible, in retrospect, to identify the fractures of the 8th and 9th ribs.

He said that it could be extremely difficult to identify fractured ribs at presentation, especially when alignment is normal or almost normal.

In the x-rays taken on 27 June, he said that the fractures were by that time much easier to see because there was then marked displacement.

MEDICAL BACKGROUNDER LIMPET

ELIZABETH ROUSSEL arrived at the Accident and Emergency Department at 1.20am on Friday 25 June 2004.

A doctor examined her and noted that she had a large amount of bruising over her right eye and around the left cheekbone.

She was drunk, abusive and aggressive. She complained of a pain to her chest on the right side.

A doctor noted her breath sounds at the time were equal on both sides.

Due to her injuries and behaviour it was decided to detain her overnight for observations with a view to her having a chest x-ray the following morning and consideration for a skull x-ray.

At 3.15am she was transferred to Giffard Ward.

Mrs Roussel was in hospital throughout Saturday. She was x-rayed and examination of the films at that time detected no fractures to the rib cage.

Nothing of any significance was recorded on her medical records that day.

A decision was made to keep her in hospital for a further night so that she could be reviewed the next day.

Her level of consciousness worsened throughout the afternoon and further CT and chest x-ray examinations were undertaken.

The results were examined at 6.45pm and showed pulmonary contusions on both sides, right worse than left. There was pneumothorax on the right side.

Doctors agreed that she should be transferred to intensive care, where she arrived at 7pm.

Mrs Roussel received treatment throughout the night but her condition worsened progressively.

At 7.50am on Monday, 29 June, her heart slowed and blood pressure disappeared. Cardio pulmonary resuscitation was started. Attempts to resuscitate Mrs Roussel were stopped and at 8.19am a doctor pronounced her dead.