A coroner has called for an urgent review of on-call rotas for doctors and specialist radiologists at all major hospitals in Ireland to ensure 24/7 cover is provided for patients who suffer acute gastro-intestinal bleeding.
It follows an inquest at Dublin District Coroner’s Court which heard about delays at St James’s Hospital in Dublin in securing out-of-hours cover from an interventionist radiologist to treat a patient with massive internal bleeding.
The inquest also heard a blood thinner given to the patient to prevent a blood clot was a contributory factor in the death of the Dublin father of five who was subsequently diagnosed with a gastro-intestinal ulcer.
Brian Doyle (66), a retired carpenter from Glenmore Park, Ballyboden, Dublin, bled to death as a result of a four-centimetre ulcer in his duodenum (part of the small intestine), despite being transfused with 17 units of blood.
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Mr Doyle had been admitted to St James’s Hospital on June 9th, 2018 and died 10 days later after failing to recover for a series of collapses on the day of his admission and suffering irreversible damage to several vital organs including his brain.
The coroner, Cróna Gallagher, returned a verdict of medical misadventure based on what she claimed was “very complex and detailed evidence.”
The coroner stressed that she was not seeking to blame any medical staff at St James’s for Mr Doyle’s death and was not criticising any of the medical decisions taken at the time.
Dr Gallagher said she would bring the attention of her findings and recommendation to the HSE for the need for 24/7 cover at hospitals to which patients with gastro-intestinal bleeding were referred.
She said she would also notify the various medical training bodies about concerns raised by several witnesses about the lack of specialist staff in the area of interventionist radiology which provides a less invasive form of treatment than surgery for patients with gastro-intestinal problems.
The deceased’s wife, Jackie Doyle, described how her husband became unwell and complained of suffering from back pain while they were out shopping in a supermarket in Rathfarnham on June 9th, 2018.
Ms Doyle told the inquest how he had collapsed after trying to provide a urine sample in the emergency department at St James’s where he had been brought by ambulance.
She said he had been given a drug by doctors to prevent a blood clot on the lung although tests subsequently confirmed he actually had a gastro-intestinal ulcer.
Ms Doyle said her husband had begun bleeding from his mouth and back passage and it was “like turning on a tap that could not be turned off as they did not know where the bleeding was.”
The inquest heard Mr Doyle never came around after being treated with interventionist radiology to stop the bleeding and had suffered brain damage.
Ms Doyle said a decision was taken to turn off his support equipment on June 18th, 2018 after the family was informed he would be in a vegetative state if he woke up. He died the following day.
A pathologist who carried out a post-mortem on Mr Doyle’s body, Siobhán Nicholson, said she believed the ulcer would have been there for “weeks to months.”
While the blood thinner administered to the patient had not caused his ulcer, Dr Nicholson said it would have made a precarious situation worse.
Liam O’Neill, a then senior house doctor at St James’s, said medical staff believed a clot on the lung was the most likely cause of Mr Doyle’s condition on admission as he had displayed no evidence of any bleeding.
Because the patient was ill during an out of hours period over a weekend and the timeframe for obtaining the results of the CT scan was uncertain, Dr O’Neill said he believed Mr Doyle should be given a blood thinner in case there was a delay in the diagnosis.
The inquest heard the drug was administered two hours after the CT scan but two hours before the results were obtained
Daragh Shields, a consultant in emergency medicine at St James’s, said he also believed it was appropriate to treat Mr Doyle with a blood thinner in advance of receiving the test results.
However, he acknowledged that emergency department staff would normally get results “in a timely fashion” and wait for them before deciding on treatment.
A critical care specialist, Jeanne Moriarty said a compounding factor in the case was Mr Doyle’s “unusual presentation” as his ulcer was “hidden” as he had shown none of the usual signs of abdominal pain or vomiting blood.
Dr Moriarty said the availability of a specialist radiologist may have helped Mr Doyle but she could not state that definitively.