A young Dublin woman died due to clotting in her lungs four days after she was discharged from Beaumont Hospital with a diagnosis of anxiety, a sitting of Dublin District Coroner’s Court has heard.
Katie Doyle (27), of Lusk, Co Dublin, died on January 4th, 2021, at Beaumont Hospital, one day after she collapsed at her home in Kelly Park due to a “massive” pulmonary embolism, or blood clots in the lungs.
In returning her verdict of medical misadventure, coroner Dr Clare Keane stated that a D-Dimer test – a blood test used to determine risk of pulmonary embolism – had not been carried out on Ms Doyle when she presented to Beaumont Hospital on New Year’s Eve with a shortness of breath and heart palpitations.
This was despite the test forming part of the hospital’s protocol in treating patients suspected of suffering clotting in the lungs, the court heard.
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In her evidence to the court, Susan Doyle, Katie’s mother, said her daughter, a “kind” and “loyal” person, had enjoyed good health for most of her life. Ms Doyle – her mother’s only child – said that she believed that her doctors knew what they were doing following her discharge from Beaumont on New Year’s Eve with a diagnosis of panic attacks, her mother told the court.
Following her daughter’s collapse on the morning of January 3rd, Susan Doyle told the court that her final words were: “I’m scared.”
The inquest heard that on December 31st, Ms Doyle complained of a shortness of breath, her heart pounding, and told her mother that something was “not right”.
That day, Ms Doyle attended her GP, Dr Fergus Murray, who referred her to Beaumont Hospital with heart palpitations. The inquest heard that in his referral note, Dr Murray noted that Ms Doyle had a heart rate of 120 and had been tachycardic for the last 24 hours.
Following triage at the hospital’s emergency department, Ms Doyle was seen by Dr Jonathan Oettlé, a senior house officer working in the hospital’s acute Covid-19 unit.
Dr Oettlé told the court that Ms Doyle had “no medical or surgical history of note”, and said that his initial impression of her was that she was comfortable. Her pulse rate was 110, he said. He calculated Ms Doyle’s Wells’ score – a test carried out to check for risk of pulmonary embolism – to be 1.5 on account of her fast heartrate, placing her at a low risk of pulmonary embolism.
Dr Oettlé told the court he had “no suspicion” of a thrombotic event, and therefore did not order a D-dimer test. He agreed that there was an element of “clinical judgment” involved in making that decision.
Dr Peadar Gilligan, a consultant in emergency medicine at Beaumont Hospital, told the court that a D-dimer test may be ordered in the context of a low Wells’ test score if there is a serious clinical concern for the patient.
Dr Gilligan said it was “clear” that Dr Oettlé did not feel that there was a serious clinical concern.
Dr Oettlé told the court that he established an alternative diagnosis of anxiety for Ms Doyle. Asked by Mr Bell if a panic attack gelled with a 24-hour period of tachycardia, Dr Oettlé said: “No, generally not.”
However, the doctor said, other factors might have contributed to her fast heartrate, such as being assessed in a busy hospital, describing the “white coat” phenomenon.
Generally, a 24-hour period of tachycardia would not “point in the direction” of a panic attack, he said. “I think that’s why [Dr Murray] sent her in.”
About 20 minutes after their initial consultation, Dr Oettlé noted that Ms Doyle’s heartrate had fallen to 101.
The doctor verbally conveyed to Ms Doyle advice on how to use a bag in the event of a panic attack, discussed danger signs, and advised that she should return if her condition deteriorated, the court heard. Dr Oettlé discharged her with a working diagnosis of panic attacks.
Dr Oettlé agreed with Mr Bell that the patient was still tachycardic on discharge.
Ms Doyle’s mother told the court her daughter still sounded like she was out of breath just she called her following her discharge from Beaumont.
The court heard how Ms Doyle did not participate in her family’s traditional New Year’s Eve celebrations because she “wasn’t feeling right”.
On the morning of January 3rd, Ms Doyle collapsed at her home. Her mother heard a bang upstairs, and went to check on her.
“She had fallen, she had hit the wall,” her mother told the court. “She couldn’t breathe, so I thought she was going to have a fit.”
The court heard how following her collapse, Ms Doyle held her mother’s hand, and her dog’s paw.
Ms Doyle’s mother called for an ambulance. When paramedics connected to Dublin Fire Brigade arrived, she told them that her daughter was not breathing.
Dr Gilligan told the court that Ms Doyle had cardiac arrest, and on arrival to Beaumont Hospital following transfer from her home in Lusk, physicians formed the impression that she had suffered a “massive” pulmonary embolism.
She was placed on advanced cardiac life support and transferred to ICU, the court heard. She died the following day, about 9pm.
Dr Brendan Doyle, a pathologist, said that the cause of death in Ms Doyle’s case was bilateral pulmonary thromboembolism.
Mr Bell submitted to the court that the D-Dimer test, “a straightforward test” that was readily available at the hospital, was not performed on Ms Doyle, and as such, her death was a case of medical misadventure.
He said that Mrs Doyle had been left “bereft” of her daughter. “There simply wasn’t sufficient investigation into the matter.”
Jane O’Neill, for Beaumont Hospital, made submissions advocating for a verdict of natural causes.
Dr Keane returned a verdict of medical misadventure. She said that, on the balance of probability, had a D-Dimer test been carried out, it would have been positive, and would have led to further investigations into Ms Doyle’s condition – including being sent for a CT pulmonary angiogram.
At the conclusion of the inquest, Ms Doyle’s mother turned to the hospital’s representatives in court and said: “For future reference, a blood test please, no matter what you think.”
In a statement released through her solicitor Dermot McNamara, she urged “all hospitals and treating physicians to strictly follow the protocols already in place by ensuring that blood tests are carried out on all patients with suspected blood clots”.
Mr McNamara said that they were considering issuing High Court proceedings against the hospital.
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