A 26-year-old woman who travelled abroad for “life-changing” gastric sleeve surgery died from a pulmonary embolism three months later, after spending almost 44 hours in an emergency department, an inquest has heard.
Èrin Dennis from Tallaght, Co Dublin considered a gastric sleeve as the safest weight-loss surgery before she travelled to Turkey for a five-day trip with her grandmother in November 2021, her mother, Theresa Dixon, told a sitting of Dublin District Coroner’s Court on Tuesday.
Eight weeks after her surgery abroad, Ms Dennis was admitted to Tallaght University Hospital on January 23rd, 2022 with dizziness, vertigo, abnormal eye movement, and vision and gait problems, and was diagnosed with a vitamin B1 deficiency.
Neurologist Dr Alan McCarthy told how Ms Dennis was vomiting up to six times a day in the eight weeks since her surgery.
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The next day Ms Dennis fell due to her gait issues, fracturing her ankle and requiring surgery.
She was administered anticoagulants to prevent clots, the dose of which had to be doubled six days into her stay following a review, as the initial dose was too low due to her weight, the inquest heard.
She was discharged on February 18th, before being readmitted on February 28th due to lower back pain. Ms Dennis was triaged and assigned to be seen within one hour, the inquest heard, but was not seen until 11 hours later.
This was due to “severe overcrowding”, according to Dr Michael Bennett, a consultant in emergency medicine at Tallaght University Hospital, who said Ms Dennis spent almost 44 hours in the emergency department until she left on March 2nd.
“When there is this level of overcrowding, clinicians in the ED are unable to see patients in a timely or safe manner,” he said.
Despite an abnormal heart rate being detected on March 2nd, an ECG was not performed, per protocol, nor were her vital signs rechecked before discharge, per policy.
Imaging confirmed kidney stones which Ms Dennis chose to treat conservatively at home rather than surgically and after returning home, she collapsed in her driveway.
“Èrin’s eyes started to roll,” her mother recalled, adding: “It was like she was falling asleep and waking up.”
“I held her head in my hands, Èrin said to me that she felt like she was falling, she said: ‘I’m sorry mum’ and then closed her eyes.”
Ms Dennis was brought back to the emergency department shortly before 6pm before she was pronounced deceased just after 7pm.
Coroner Dr Clare Keane recorded the cause of death as pulmonary embolism, secondary to deep vein thrombosis which originated in her left femoral vein.
She returned a narrative verdict, stretching back to the gastric sleeve surgery abroad, for the “complex” case.
Alongside a high BMI, several issues arising from the gastric sleeve surgery could have contributed to her death, she said, including the B1 deficiency which led to her fall and fracture.
Immobility while travelling, during her admission or following her ankle fracture, could have also contributed to the clot.
She remarked that Ms Dennis had “great hopes” for the gastric sleeve surgery, one that she hoped would be “life-changing”.
Repeating recommendations made by the hospital, which she endorsed, Dr Keane said the risk posed to those who travelled to non-EU countries must continue to be highlighted.
Counsel for the family, Nicola Delaney, noted that the hospital apologised for failings identified following a review, though she said the family had heard various apologies from hospitals and the HSE in the media “a lot lately”, questioning how many times must one be made before it was “sincere”.
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