If this case makes the optometry profession reflect on their practices and review their policies to prevent it happening to anyone again, or encourages other parents to take their children to get their eyes tested with the knowledge that any serious issues would be picked up, then it will be worthwhile.’
These were the words of Suffolk Police senior investigating officer Detective Superintendent Tonya Antonis outside Ipswich Crown court 20 minutes after locum optometrist Honey Rose was found guilty of manslaughter by gross negligence last week (July 15).
Regardless what verdict was reached, a criminal trial of an optometrist for manslaughter through negligence was always going to have huge ramifications on not just optometry, but the wider medical profession too. It was the first time an eye care professional had faced such charges.
The case had naturally caught the attention of local and national news, but it was also on the radar of The Spectator. Writing in a blog at the start of the trial, Ross Clark said there would be very serious repercussions if doctors and scientists were going to be dragged into the courts over alleged misjudgements.
He said: ‘Doctors, terrified of failing to spot lurking conditions, are never going to let a case go without referring the patient for further examination. Any spot, any shadow, any abnormality which could conceivably indicate a serious condition will be seized upon. Hospitals and consulting rooms will fill up with patients called in to have further examinations on what are almost certainly benign conditions but which no doctor or nurse will dare to dismiss as such.’
With the guilty verdict returned by a jury of eight men and four women in a little over three hours, optometry must now assess whether its practices need to be changed or whether the tragic death of Vincent Barker is solely down to a failure in duty of care by Rose during his examination.
Associations were quick to offer their condolences to Barker’s family, but did not offer much more because Rose was still the subject to a fitness to practice suspension. The Association of Optometrists (AOP), of which Rose is a member, did say it was disappointed with the outcome of the case. The College of Optometrists explained the role and scope of the optometrist in practice and in a member bulletin, made it clear that Rose was not a member.
Simon Kelly, a consultant ophthalmologist at Royal Bolton Hospitals NHS Foundation Trust, Beaumont Hospital, Bolton, said the verdict would have an impact on not just high street optometry, but ophthalmology too. ‘This conviction is not in my opinion the way forward to improve the diagnosis of papilloedema in the community or indeed patient safety,’ he said.
In the short to medium term it’s likely that more optometrists are going to refer patients to eye hospitals, which are already overstretched, because of a fear of missing pathology.
Practitioner-level reaction has been mixed. BBR Optometry chairman Nick Rumney moved quickly to allay fears among patients: ‘I know people will have concerns following this court case and, firstly, I want patients to know that papilloedema is rare and eye examinations carried out by all optometrists, including particularly stringent guidelines applied to every child’s examination, is designed to provide peace of mind.
‘BBR is regulated by the General Optical Council (GOC) and all of our optometrists are members or fellows of the College of Optometrists which issues such guidance. This is to ensure we are capable of detecting disease, injury or abnormality in the eye or elsewhere.
‘These standards also cover how to conduct a routine eye exam, how to examine children, the review of clinical images taken by an assistant, how an optometrist should safely and correctly keep patient records and when a patient should be referred.’
Online optometry forum theoptom.com has highlighted a feeling of uncertainty over the verdict, and some members have considered a crowd funding project to help Rose get a new defence team in the event of any appeal.
Police investigation
Detective Superintendent Antonis said the case had been a complex enquiry that was initially submitted to police as the sudden unexplained death of a child, but as investigations went on, it started to become clear that Barker had been subjected to a number of failures during his trip to Boots Opticians, Upper Brook Stret, Ipswich, in February 2012.
‘In these circumstances we start a full investigation to understand why that child has died and if we believe there are criminal acts involved we aim to put the facts before a court to bring those responsible to justice.
‘During the course of this enquiry we discovered that, in our view, there was a criminal case to answer, leading to Honey Rose being charged. However, this case was about much more than justice for Vinnie’s family.
‘Whatever the outcome of the trial it was never going to bring Vinnie back and it was never their aim to see Honey Rose imprisoned, they only want to raise awareness of the issue so that something positive can come from his death,’ she said.
Trying to find a positive aspect from Barker’s death was also the main concern for parents, Ian and Joanne Barker: ‘Our main concern has always been the accountability of those we entrust with our own health and the health of those we love.
‘It is the responsibility of individuals and the organisation they work for to perform their duties to the expected levels of good practice without exception. The actions of professionals or their failure to act to a standard at which they are required to perform should not go without consequence.
‘It is not our intention to damage the reputation of optometrists, but actually to raise awareness and promote the health benefits and value of good optometry. Because, we believe, without doubt, that if our son had received the duty of care he was owed on February 15 2012, he would still be with us today.’
The hearing
The nine-day hearing heard how Vincent Barker died in July 2012 after fluid built up in his brain. A post-mortem examination revealed that he had died from previously undiagnosed hydrocephalus – a build-up of fluid on his brain – which led to an increase in pressure in his skull. Five months earlier he attended an eye examination performed by Rose in the Boots Opticians.
Addressing the jury at the start of the trial, prosecutor Jonathan Rees QC said retinal images taken during his eye test had showed he was suffering from bilateral papilloedema. But the condition was not noticed by Rose during her examination, even though the images were clearly ‘abnormal’.
Rees said that any competent optometrist would have noticed the symptoms and referred him to hospital for urgent treatment, but he was instead allowed to return to his home in Ipswich with his mother.
The court head that his life could have been saved if the condition had been recognised and he had undergone surgery by a neurosurgeon to relieve the pressure of fluid on his brain.
Rees added: ‘This procedure would have prevented him from dying on July 13 2013, and he would have continued to enjoy a normal life as a young boy. Put another way, the defendant’s failure to detect the swelling of Vinnie’s optic discs was a significant contributory factor to his premature death. She either simply didn’t bother to examine the back of his eyes, or carried out such a slapdash examination that she did not focus on his optic discs.’
The court heard that Barker had retinal photographs taken by an ‘optical consultant’ before the eye examination with Rose. She told police that she believed the staff member had accidentally shown her the retinal images from Vinnie’s previous eye test in 2011 which showed no signs of ill health.
Rose also claimed that she had used an ophthalmoscope to look into the back of his eyes, but he was showing pain and aversion to light so she stopped using the instrument and had to rely on the retinal images.
But Vincent’s mother, who took him for the eye test with his sister Amber, said he had shown no signs of being sensitive to light during the test and nothing was mentioned by Rose at the time or indeed recorded on patient notes.
In her testimony, Rose recalled a voluntary police interview in which she had said that she had worked four times previously at the Boots branch and had based her assessment of the patient on retinal photographs which showed his optic discs were healthy. But she said she did not know how to operate the screen on the camera and asked one of her colleagues to display it.
She claimed that it appeared she had accidentally been shown the images form his earlier eye test and she had never previously seen the ones which showed a ‘completely pathological problem.’
Optical consultant Carol Cocker, who was working at the Upper Brook Street practice at the time, appeared in court to explain her role in practice, which included taking retinal images. Cocker said she received no formal training on interpretation of the images, but would still pre-warn the optometrists about things like shadows on the retina.
Cocker was not able to recall whether she took Vincent Barker’s retinal photos, but did speak about technical problems with the systems at the Boots practice. These included a malfunctioning shutter and a faulty display. This was relayed to the practice manager, but no logs or reports were filed by her. The jury also heard that there had been a power cut at the practice on the day in question, but the technology and innovations witness for Boots Opticians, Martin Donoghue, said this would only have affected the practice management systems.
In an agreed statement to police Rose also claimed she may not have had sufficient instructions from the multiple in the workings of its IT systems. During her time there, she said that help with systems was requested but not always given. The statement also included details of Rose’s approach to children’s eye examinations and her preference for use of fundus images instead of a slit lamp and ophthalmoscope. This was because she preferred to work further away from the young patient.
Closing statements from the prosecution said that throughout the case, Rose had attempted to shift blame away from herself. Defence argued there was simply not enough evidence to return a guilty verdict and the tests performed on the child would have to have been a departure from her usual routine. The only unusual aspect was the element of photophobia and lack of co-operation, which the defence said had been adequately explained by Rose. The jury did not agree.
The coming months are likely to see optometry regulation and retailing asking itself some tough questions.
A statement from Ian and Joanne Barker added: ‘The outcome of this case does not change our life sentence; we will never be able to fully accept that our special little boy is never coming home. The void left in our lives will never heal and the ripple effect to those around us is immense.
‘As parents the distress of witnessing your child’s life from start to end in just eight short years is excruciatingly hard and nonsensical. The decision of a jury or judge cannot bring Vinnie back or undo the devastation of his death. A guilty verdict would never make us winners; our loss is simply too great.’
