Original subtitles

James, sorry to wake you, but we've got a situation.

Rosie Newman.

You need to get here now!

Rosie, please stop. Don't move!

From these notes, it seems your assessment of Rosie was very brief.

Dr McAllister had asked me to attend a Mental Health Act assessment.

Police!

So you didn't ask Dr Ford to attend Toni's sectioning?

No.

Rosie was under-sedated when you saw her in A&E.

I was clear she needed to take the medication.

You arrived nearly an hour after Bernadette called.

I was at my girlfriend's, OK?

You're aware that the reg on call

must be within 30 minutes of the hospital?

Four days, she was sat on that ward for four days.

This is a waste of time. You should be asking Dr Hernandez

what went wrong with Rosie's birth.

Rosie needed to see a psychiatrist, but...

Maria... ..she asked me to cancel the referral.

Mr Mansoor delivered Toni's first baby naturally

without any significant complications.

SHE YELLS

There's no time. She's having her baby now.

What are you doing?

Dr Ford, he made several mistakes.

Make sure the right people know that.

Due to the death of a vulnerable patient,

the integrated care board is seriously considering

closing us down. What?

DANCE MUSIC PLAYS

My head's pounding, and my chest hurts.

Take us to A&E! Quickly!

I wasn't expecting you tonight.

We were sharing a cab together,

and she must've overdosed because she was getting more and more ill,

erm... and I just panicked, and I took her...

I took to her North Yorkshire instead of QM

cos of the investigation. Have you taken drugs?

No. Course not. Did you give her any drugs?

I had one in my pocket, and she... she took it.

For God's sake, James!

Please tell me you didn't tell them your name?

Course I didn't. You are under investigation.

Why are you going out with your pill-popping mates?

Cos I'm stressed out of my fucking mind! And...

And I know I should have taken her to QM instead of North Yorkshire.

And I know... I know it sounds bad...

No, it doesn't just sound bad James, it sounds career-ending.

Erm, let me call North Yorkshire.

I'll see if she's OK. What you gonna say?

"Hi, I'm the doctor from earlier who dumped a drugged-out woman

"in A&E and legged it?" How's that sound?

Idiot!

And did anything else happen between you?

No. Nothing.

I swear.

Well, you got her to hospital. So...

..did the right thing.

I've got a friend who works in North Yorkshire A&E.

So I can call him.

Thank you.

Thanks, John.

Yeah. I owe you one.

OK. Yeah, speak soon.

So, she is stable.

Thank you.

Oh... You're welcome.

We'll be late.

That doesn't matter. You can do what you want - you're the boss.

Precisely.

I'm getting a bit sick of all this...

sneaking around.

Well, er, we don't really have a choice.

Because if anyone found out, I would lose my job.

You'd get another one. That is true.

I heard that the NHS are really desperate for excellent doctors.

Yeah.

And you're under investigation, so...

..none of this can come out.

RADIO PLAYS

SIGHS

'We appreciate you coming in at such short notice, Dr Hernandez.'

Happy to help.

We have a couple of things around Rosie Newman's delivery at QM

we were hoping you could clear up.

Well, I didn't deliver Rosie's baby, so...

probably not the best person to ask,

but I'll do my best to answer your questions.

Rosie was on the postnatal ward for four days,

but it's not clear why from the notes.

Well, without the notes in front of me, it's hard to comment.

Well, fortunately, we have those.

Er, yes, I remember.

We were worried she had an infection.

So we wanted to treat her and ensure she was fit to go home.

No mystery.

You said previously

you had no concerns about Rosie Newman's mental state

until Mr Newman brought it up in clinic.

That's right. Well, Maria Carter, Rosie's midwife,

claims she was concerned about Rosie's mental state

during the four days on the postnatal ward. Really?

She never said that to me. Did she document that in the notes?

No, but Maria said she referred Rosie to psychiatry,

a referral she also said you told her to cancel.

SHE SCOFFS

Well, that's obviously a lie.

You do know she's been suspended?

We're aware she's under investigation

for an unrelated incident, yes.

Yeah, because she's difficult.

She's an experienced midwife,

but she thinks she knows better than everyone else, the doctors included.

She didn't listen and frequently made poor choices

against doctors' advice.

She put patients at risk.

OK. We requested information from psychiatry and switchboard

about any referrals made from obstetrics

during the four days Rosie was on your ward.

I'm sure we'll get to the bottom of it.

Even if Maria made a referral to psychiatry,

she never told me anything about it.

Thank you. Thank you.

I mean, Maria said Sophia had told her to cancel the referral,

so either she's lying or Sophia is.

Well, they both have good reasons to lie, as does Dr Ford.

The switchboard and psychiatry info has arrived.

They've sent call logs, copies of the handover book and on-call rota.

Great. OK. You two go over all of that.

We need to find out if anyone made calls about Rosie.

Hi.

Dr Ford from psychiatry.

Toni was on my ward before the birth.

Hi, I'm Deepa. I'm one of the midwives over at Stamford.

Nice to meet you. Sorry I'm so late.

It's fine.

I have Toni's notes, and copies have been sent to the mother baby unit,

so we're good to go. Great.

Sorry to keep you, Toni. We'll be off soon.

Hiya, Toni, how you doing? Are you OK?

Uh.

If he starts crying while we're travelling,

you can soothe Sam by touching him through here.

Do you want to have a go?

Toni, it's all right for you to touch Sam. He's your baby.

Toni has shown some nervousness about being around the baby alone,

given what happened last time. What do you mean?

The skull fracture from her first baby, Apple,

from when Toni dropped her on the postnatal ward.

I'm sure it was documented by the midwife. Alison Masters.

Here it is.

It was a tiny linear fracture, and the baby recovered well,

but there was already bruising from the forceps delivery.

Of course, Apple. I just...

I forgot. Don't worry.

We'll do lots of work around attachment while she's with us.

She'll get there. Good to go. WOMAN: Yeah.

Hiya. Hi.

I'm looking for one of your midwives.

Alison Masters? Yes?

I'm Dr Ford from psychiatry.

My team's been looking after Toni Campbell-Brown.

She wasn't allocated to me.

I know, but you were her midwife

for her first birth a couple of years ago, right?

Maybe, but that's quite a long time ago.

Do you remember her ever, erm... dropping her baby?

While she was here at QM?

Stamford MBU, they seem to think that she dropped her baby?

You shouldn't be asking me about this.

So did Toni drop the baby or didn't she?

Please, leave me alone.

Whatever you're trying to do, I don't wanna be involved.

I don't want to end up like Maria.

What? Who's Maria? Is she another midwife?

What are you doing?

We just discharged your patient.

There's no reason for you to be here.

Why didn't say Toni's first baby had a forceps delivery

and skull fracture? What?

Did Toni really drop the baby, or was it the forceps delivery?

Either way, you said there were no complications.

I... I don't have time for this.

Who's Maria?

Who is she, and why was that midwife scared of ending up like her?

Get off my ward now.

What the hell do you think you're doing?

During the four days Rosie was on the postnatal ward,

switchboard put seven calls through from obstetrics to psychiatry.

By matching the call log with the dates and names

in the handover book, I eliminated all the calls

except these two... made from the postnatal ward

to psychiatry the same day Rosie was discharged,

but there's no mention of any referral

in the handover book that day.

Because the referral was cancelled.

Yes, so the first call could be Maria making the referral

and the second is her cancelling, half hour later.

But unless Maria tells us what she said in those calls,

it's still just her word against Sophia's.

Well, there's also the registrar

that was on call during that shift.

a locum doctor, Ava Lawal.

She could confirm the calls, what was said.

What are the chances of a locum doctor remembering a phone call

from two months ago? It's worth a shot.

If she confirms Maria rang about Rosie,

then it's very likely Sophia was lying.

Then we'll just have to work out why.

Hi, er, I'm here to see Dr Lawal. Yes, of course.

One moment, please. Thank you.

Hello, Doctor, I've got a gentleman in reception for you.

I write all my referrals in here, so if it's happened,

it'll be in here somewhere.

Ah! Rosie Newman, psych review prior to discharge,

from the postnatal ward, referred by...

Didn't write down the name of the referrer.

But someone called a little while after to cancel.

See, I've written here, "fine to go home".

Who cancelled? Was it the same person?

Honestly, I don't remember.

Do the names Maria Carter or Sophia Hernandez mean anything? Sorry.

But if it helps, it's normally a doctor that makes a referral,

but it could also be a midwife.

So Maria did make those calls.

Not necessarily. We assumed she did, but she never actually said that.

Her lawyer interrupted her

before she had a chance to answer the question.

Dr Lawal couldn't remember

who made the calls or whether it was the same person,

but she did say most referrals come from doctors.

So, what, you think Maria made the referral,

and then Sophia cancelled it?

Yeah, and given what subsequently happened,

Dr Hernandez has every reason to lie about that.

OK, but why?

She's a reg under pressure to free up beds,

and Maria's just a midwife, and she didn't believe her.

It's not enough.

If we knew why Rosie was on the ward for four days, that'd help.

We've got all Rosie's maternity notes.

Right. We need to go back over the entries for those four days again

really carefully - doctors, nurses, midwives, physios, everything.

There's got to be something in here.

Divide up the days then get back to me.

Great.

James, have you got a minute? What is it?

Aislene's complaining again about stomach pain and...

She will do anything to get your attention, bro.

I dunno how you put up with it.

She's got borderline personality disorder,

so she'll be attached to you before you know it.

James, this time, I think she might be telling the truth.

She hasn't had any breakfast, refusing her meds...

It's serious, then. We know she loves her benzos.

James, please. She'll keep asking until you see her.

Is it a... a sharp, stabbing pain, or is it more of a dull ache?

Sharp, stabbing.

Just let me know if you feel any pain at any time. Hm.

Aislene.

You can't do that.

Sorry, Dr Ford.

Do you actually have any pain anywhere?

OK.

DOOR OPENS, CLOSES

SHE SOBS

Eric!

Mala's really looking forward to Bethan's party.

She's tried on a million different sparkly outfits.

Well, Sarah's gone totally overboard with the plans.

You'd think it was a wedding, not a birthday party for a ten-year-old.

How's the investigation going? Very well.

I've been impressed with the MIU so far.

It's just, erm...

..the doctor they're investigating, Dr Ford.

He was being very aggressive with Sophia earlier today.

Really? Yes.

I'd go so far as to say he was harassing her.

What do we know about him?

We've got some background stuff on him, but I can step that up.

I'll also have a word with Kate, see how she finds him as a trainee.

Thank you. I'd appreciate that.

MUSIC: 'Blue Monday' by New Order

# Thought I was mistaken

# I thought I heard your words... #

TURNS ENGINE OFF, MUSIC STOPS

You're home early.

How was work?

Who was that? Oh, Dr Munro.

He's one of my tutors.

And that's normal, is it?

A tutor calling to see a student at home?

He was here because I'm thinking of quitting med school.

And he was trying to persuade me not to.

Well, I mean if it's the uni, we can move you.

There's lots of different medical schools.

I just... wonder whether there are other things

I could do with my life.

It's not...

Is there something going on... with him?

That's the reason you suddenly want to quit medicine?

No, Mum, I'm quitting cos I'm not enjoying it.

I never have. It's got nothing to do with Ben.

Ben?! Rubi, he's your tutor.

It's not a big deal. Of course it is!

It's a total and utter abuse of power, him preying on you.

He's not preying on me, Mum. We're both adults.

No. He's an adult. You're his student.

You're so patronising.

Rubi...

Look, for God's sake,

do not throw away your future because of this man.

Believe me, you'll regret it. It's my life, Mum.

Not yours!

KNOCKING

BARKING

What are you doing here?

Do not speak to the MIU again, or anyone at QM.

I haven't.

They called me.

Why? They're getting close, aren't they?

Keep your mouth shut, Maria.

Otherwise,

I will make your life significantly worse than it already is.

Believe me.

MICROWAVE BUTTONS BEEP

Fizz has been off work sick since our night out.

Did you two... Did you hook up?

No.

You left together. No, we, erm...

we left at the same time, we-we didn't...

..didn't leave together. Did you see her get a taxi?

She was fine when I last saw her.

Hm.

If you're worried about her, you should give her a call.

No, I did. She's not answering.

Hm. Yeah.

MICROWAVE BEEPS

Erm...

Yeah, yeah, that should be fine, thank you.

PAGER BEEPS

Right, what have we got?

MEDITATION MUSIC PLAYS

Claire Martin. 31-year old primip. Her BP's sky high.

I thought the obs machine wasn't working, so I got another one,

but her reading's still really high.

SWITCHES OFF MUSIC

Hi, Claire, my name's Dr Hernandez.

I'm one of the on-call obstetric doctors.

How long has she been like this? I don't know.

I went out to get the other machine. She was like this when I returned.

Right, Claire, I'm just going to examine you.

That's it.

She's wet herself.

Has she? Must have happened when I stepped out.

We're short-staffed. I'm looking after three others.

Does she have a history of epilepsy? What? No, don't think so.

Claire, do you have a history of epilepsy? No.

Right, I'm worried you might have had a seizure. What?

Have you heard of pre-eclampsia? It causes high blood pressure,

and it can lead to seizures if not managed. I think you're eclamptic.

No, I'm just exhausted from all the pushing.

We need to move her to labour and get the blood pressure down.

She needs IV labetalol and a magnesium sulphate infusion.

Can't we just do that here?

How long have you been qualified?

Claire, we're going to move you to the labour ward.

I wanna give birth here, naturally. It's all in my birth plan.

You said I could do that! There's no time to explain,

but it is in your best interests and your baby's.

Why? What's wrong with him?

Nothing yet, but if we don't get him out quickly, there might be.

Call the porters. We're taking her straight to theatre. What?

You're not gonna do a vaginal delivery? There's no time.

She needs a C-section. She wants to give birth naturally.

You don't even know if she had a seizure!

Claire, I need to consent you for an emergency caesarean section.

Please, no. They said I could do it normally.

I don't want a caesarean. Your blood pressure is really high.

I think you've been having seizures, and every time that happens,

your baby is starved of oxygen, and you could die.

The quickest way of stopping these seizures

is to get your baby out via a c-section, OK?

OK. OK, let's go.

Right, I'm gonna explain to you the intended benefits

to secure the delivery of your baby.

There are serious and frequently occurring risks.

Infection is six in a hundred. Haemorrhage is five in one thousand.

Foetal lacerations two in a hundred.

Your anaesthesia risk will be discussed by an anaesthetist...

Out.

Apply some pressure. Claire, you're just gonna feel some pressure.

But we're nearly there. You're gonna meet you baby very soon.

OK. Baby's out.

Clamp and cut the cord.

Yep.

Clamping.

Cord cut.

OK, I'll let you deliver the placenta.

There we go.

Here we are.

BABY CRIES

Here you go, Claire.

You've got a gorgeous little boy, Claire.

Thank you. Well done.

CRYING CONTINUES

Green armytage, please.

We've been through the notes,

and the one thing that keeps coming up is infection. Go on.

From day one, Rosie mentions symptoms of infection -

erm, fever, pain, swelling.

Blood tests were ordered, but that's where it gets interesting.

They're not in the notes.

Right.

Remind me what Sophia said in her interview about the infection?

She said, "We were worried she had an infection.

"We wanted to treat her and ensure she was fit and well to go home."

"We were worried."

You're both saying it was Rosie bringing up infection?

It's the same on day three and four. Show me those notes again.

If Rosie didn't have an infection, why keep her in for four days?

One of her results must have been positive.

And Sophia mentioned treatment, I mean, what were they treating?

Right, Kathy, get onto QM's lab. I want the results

of every single blood test Rosie had during those four days.

I want copies of drug charts and any investigations ordered.

OK. All right?

Hey, good job.

Er, sorry. Sorry.

Sorry, everyone.

Er, we had five deliveries overnight -

three on the birthing unit, two on the labour ward.

I'll start with Claire Martin.

31-year-old primip, 41 weeks,

initially due to deliver on the birthing unit with Ellie,

but after suspected seizures began,

we moved her to theatre and delivered her baby by c-section.

Both mum and baby are doing well.

Right, next up is Jodie Law. Hang on.

You witnessed a seizure?

No, but when Ellie called me in to review Claire,

there were obvious signs of seizure activity -

diminished pupillary responses,

brisk tendon reflexes.

She'd wet the bed, and her BP was 170 over 110.

OK, so why didn't you try conservative management first?

The... The seizure was unwitnessed.

Neither Ellie nor the patient could say how long

seizures had been going on for.

I thought it was best not to hang about, get the baby out quickly.

Like I said, both mother and baby are both doing really well.

From my understanding,

when you arrived, the patient had already started to push.

The most appropriate course of action

was to lower blood pressure, set up the magnesium infusion

and proceed with an assisted forceps or ventouse delivery.

Why didn't you do that? Because she panicked.

Ellie says the patient wanted a vaginal delivery.

She was terrified of going to theatre,

but you told her the baby would die if she didn't have a caesarean,

which is categorically not true.

Yeah, with all due respect,

Ellie didn't know how to work the obs machine... That's a lie.

The risk to the baby and mum was high.

And the outcome is most important - healthy mum, healthy baby.

I made what I thought was

the correct clinical decision at the time.

But you didn't make the right decision, Sophia.

You forced a patient to have major surgery that she didn't want

and didn't need, and you've cost this department thousands of pounds

by doing an expensive, unnecessary procedure.

I delivered the baby safely.

I mean, if this woman wants to give birth again at QM,

she'll probably demand another caesarean.

That's what you've saddled us with. Arun,

at the next M&M meeting, can you make it quite clear

that it's your trainee

that's driving up the c-section rate this month?

I'm not having her mistakes affecting my outcomes.

Emma, everyone knows it's your junior who's scalpel-happy.

Why do you think all the theatre staff call him Sweeney Todd?

RINGING IN SOPHIA'S HEAD

Look, Sophia, you've improved over the past few months,

but if you're still not confident

making important out-of-hours decisions,

we need to consider more senior support for you on call.

I just thought, given what happened

with Rosie Newman and Toni Campbell-Brown,

we shouldn't be taking unnecessary risks with our patients, that's all.

This department isn't under scrutiny, Sophia. You are.

There's a difference.

If anything like this ever happens again, just give one of us a call.

That's what we're here for.

Right, who's next?

Er, yeah, erm...

LAUGHING Sorry, sorry, sorry. I was, erm...

Ah, Dr Ford, er,

Dr Sawers will be joining us for your supervision today.

I've spoken to the Deanery, and given what's going on,

and with you being so close to becoming a consultant,

it would be a shame for you to fall at the last hurdle,

so to speak, so...

The idea being Dr Sawers will be joining us

for your weekly supervisions

and reporting directly back to the Deanery on how you're doing.

I-I thought supervisions were meant to be protected trainee time.

Oh, they are. They are. They are.

Just do what you usually do, pretend I'm not here.

CLEARS HIS THROAT

This week, I thought we could talk about Toni Campbell-Brown.

She's a patient with bipolar disorder

who gave birth only nine days ago.

I thought we could talk about her first and second births

and what we could learn about both as a team.

How so?

I was recently told that while at QM...

..Toni's first baby suffered a skull fracture.

Well, there's nothing in the notes about a skull fracture, James.

Also, Toni is quite a complicated case,

physically, and really the purpose of these supervisions

is to focus on more complex psychiatry.

So, in light of that,

why don't we discuss someone like Samira Saed, for example?

OK.

Erm, Samira Saed is a 23-year-old patient

with schizoaffective disorder.

DOOR OPENS

Not knocking any more?

Rosie's blood test results came through from the lab.

These are all normal.

Every single marker of infection is normal.

So she didn't have an infection. No.

So Rosie keeps bringing up infection, not the medical staff.

Despite their reassurance, she queries the results incessantly.

She was pathologically anxious about infection.

It was the first sign that something mentally wasn't right,

and all of the medical staff on that ward dismissed it.

Except Maria.

We need to talk to her again.

Contact her directly, not through the lawyer,

and explain where we're at.

And we should speak to the Trust urgently.

I mean, Maria told Dr Hernandez about Rosie's concerns,

but she never considered it might be something else.

Thanks.

Oh, er, James, Dr McAllister was looking for you.

Where is she, in her office?

Think she's outside, on her break or something.

Thanks.

SIREN BLARES

Kate.

Looking for me? Yeah. Erm...

Can we go somewhere private?

A bullying complaint has been made against you.

What? Yeah.

By who? Sophia Hernandez.

Apparently you stormed onto the postnatal ward

and had a go at some midwife,

and then when she tried to intervene, you...

what, you grabbed her? Is that true?

No. No, erm...

No, I went to the ward I... I... I spoke with the midwife,

I asked her some questions, she didn't answer me, so I asked...

..Sophia some questions, she didn't answer me and then, erm...

..and then, yeah, I kind of grabbed her,

but obviously she knew that I didn't... I didn't mean it.

Fuck!

Is this about Toni's baby and the skull fracture?

I just wanted to know what happened.

They're... gonna to use this to get rid of me, aren't they?

Aren't they? Cos it's... it's Rosie first,

now it's Toni, now it's this. James, James, just calm down.

It's not happening.

You just need to do some mandatory training on bullying,

under my supervision.

And Eric's. Yeah.

Yeah.

So, I've been thinking,

erm...

..what with everything going on, and now the Deanery getting involved,

I think perhaps we should cool it.

Just until this investigation's over.

I don't have anyone else, Kate.

I need you. Yeah. You've got me.

Just more as your clinical supervisor

than your girlfriend or whatever.

HE EXHALES

Hey.

Hey, come on.

It's for your welfare, OK?

Come on.

GASPING

SHE CRIES

PHONE BUZZES

ALARM RINGS

Kwame, what's going on? Aislene.

There's tape around her neck. I can't get it off.

It's too tight! Somebody get the resus trolley and call 999.

Precious, Precious, could you hold her arm like this...?

Steady, don't hold it like that. How did she get it so tight?

Where did she get this from?

Fuck!

I can't find ligature cutters. Get some scissors or a knife!

I don't know where that is. Just find something, Kwame!

And turn the fucking alarm off!

What's going on? Scissors!

Found any?

No. Try there. Try there.

Turn the alarm off.

It's all I could find. All right.

OK, nearly there.

GASPS

LAUGHS

Bernadette.

Can you do her physical before the ambulance gets here?

Hi. Aislene, can you hear me? We just need to check you over.

Thank you for meeting us so quickly. Not at all.

I'm keen to hear how the investigation into Dr Ford's going.

Actually, it's, er, not Dr Ford we'd like to discuss.

Oh? During the course of our investigation,

we've become aware of some...

concerning issues about Dr Hernandez.

What kind of issues?

Rosie Newman repeatedly reported symptoms

of a non-existent infection when she was on the postnatal ward.

We think this was the first sign of Rosie's emerging mental illness,

which Dr Hernandez dismissed.

Really?

We believe Dr Hernandez then went on to cancel a referral to psychiatry

before discharging her against the midwife's advice.

Are you sure?

We spoke to Maria Carter, Rosie's midwife.

What she said was worrying

and points to a wider issue we've started to notice

regarding Dr Hernandez's attitude

towards certain departments and members of staff.

It's something we'd like to explore further.

Are you aware Maria Carter is currently under investigation?

Yes, but we don't know why. Unfortunately,

owing to the criminal nature of the enquiry,

I'm not at liberty to disclose the details,

but the charges against her are very serious,

and you shouldn't consider her a reliable

or credible source of information.

OK.

If failings within psychiatry contributed

to the mismanagement of Rosie, then I'm happy for you to look into that.

But unless there's a formal complaint about Dr Hernandez,

I feel you're wasting your time.

You need to keep Rosie Newman at the heart of your investigation.

Please don't lose sight of her, or the loss to her family.

We haven't.

Let's not forget,

Dr Ford failed to spot the signs of Rosie Newman's psychosis

during his initial review, which ultimately led to her death.

It's our opinion that he is unreliable,

unprofessional and a liability to this trust,

and more importantly, to its patients.

Why did you do that, Aislene?

You were doing so well.

SHE CRIES

We asked you as a trust to look at Dr Ford's fitness to practice.

That's our primary concern, as it should be yours.

And it's best you stick to the job you were brought in to do.

That was horrific.

Yeah.

BUZZER

Never stops.

Hello, this is Willow Ward?

Yeah, we've literally just had a bed come free.

Right. See you shortly.

We've got a new admission coming in.

Hi, Dr Asamoah, Willow Ward.

What have you got for me? 33-year-old female,

currently manic following an overdose.

Are you ready? Coming.

We had to sedate her quite heavily for the journey. Lovely.

Oh, and she likes to be called Fizz.

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