Terms of Reference



Terms of Reference (Revised November 2008)*

Department of Health, Social Services & Public Safety

The Health and Personal Social Services (Northern Ireland) Order 1972

In pursuance of the powers conferred on it by Article 54 and Schedule 8 to the Health and Personal Social Services (Northern Ireland) Order 1972, the Department of Health, Social Services and Public Safety hereby appoints Mr John O’Hara QC to hold an Inquiry into the events surrounding and following the deaths of Adam Strain and Raychel Ferguson, with particular reference to:

  1. The care and treatment of Adam Strain and Raychel Ferguson, especially in relation to the management of fluid balance and the choice and administration of intravenous fluids in each case.

  2. The actions of the statutory authorities, other organisations and responsible individuals concerned in the procedures, investigations and events which followed the deaths of Adam Strain and Raychel Ferguson.

  3. The communications with and explanations given to the respective families and others by the relevant authorities.  

In addition, Mr O’Hara will:

(a) Report by 1 June 2005 or such date as may be agreed with the Department, on the areas specifically identified above and, at his discretion, examine and report on any other matters which arise in connection with the Inquiry.

(b) Make such recommendations to the Department of Health, Social services and Public Safety as he considers necessary and appropriate.


*Footnote

After the terms of reference were amended by the Minister in November 2008 to exclude any inquiry into the events surrounding and following the death of Lucy Crawford in 2000, the Chairman had to consider how they would be interpreted in their new form.  He issued a consultation paper in June 2009 and having considered the various responses, decided on the following approach:

“.... the terms still permit and indeed require an investigation into the events which followed Lucy’s death such as the failure to identify the correct cause of death and the alleged Sperrin Lakeland cover up because they contributed, arguably, to the death of Raychel in Altnagelvin.  This reflects the contention that had the circumstances of Lucy’s death been identified correctly, and had lessons been learned from the way in which fluids were administered to her, defective fluid management would not have occurred so soon afterwards (only 14 months later) in Altnagelvin, a hospital within the same Western Health and Social Services Board area.”




Original Terms of Reference

Department of Health, Social Services & Public Safety

The Health and Personal Social Services (Northern Ireland) Order 1972

In pursuance of the powers conferred on it by Article 54 and Schedule 8 to the Health and Personal Social Services (Northern Ireland) Order 1972 , the Department of Health, Social Services and Public Safety hereby appoints Mr John O’Hara QC to hold an Inquiry into the events surrounding and following the deaths of Adam Strain, Lucy Crawford and Raychel Ferguson, with particular reference to:

  1. The care and treatment of Adam Strain, Lucy Crawford and Raychel Ferguson, especially in relation to the management of fluid balance and the choice and administration of intravenous fluids in each case.

  2. The actions of the statutory authorities, other organisations and responsible individuals concerned in the procedures, investigations and events which followed the deaths of Adam Strain, Lucy Crawford and Raychel Ferguson.

  3. The communications with and explanations given to the respective families and others by the relevant authorities.

In addition, Mr O’Hara will:

  1. Report by 1 June 2005 or such other date as may be agreed with the Department, on the areas specifically identified above and, at his discretion, examine and report on any other relevant matters which arise in connection with the Inquiry.

  2. Make such recommendations to the Department of Health, Social Services and Public Safety as he considers necessary and appropriate.