A young mother of two collapsed unconscious at home, days after being sent home from A&E due to a shortage of doctors, an inquiry into her death heard.
Coroner for West Galway, Dr Ciaran MacLoughlin, compared the break-down in communications at the hospital to the incidents that led to the death of Savita Halappanavar three years earlier.
He said that this ‘final and terminal event’ may not have occurred had anomalies seen in one of her blood tests – her troponin levels, which is used to indicate damage to the heart muscle, were elevated – had been communicated to her or her family.
“It is a sad situation for all of us when we have a hospital with the best experienced staff in the country, and yet it cannot function – something is radically wrong,” Dr MacLoughlin said.
He added that the staff shortages and overcrowding at UHG – which has the second busiest emergency department in the State – was a question of national policy, but also of major public concern.
Eniola Adekeye (41), of Gleann Rua, Renmore, died from cardio respiratory failure, due to a bilateral pulmonary thromboemboli on February 5 2015. She was studying for a B.A. degree in Child Studies at the time.
Her husband, Adedotun, told the Inquiry at Galway Courthouse on Thursday that she had initially been rushed to hospital in the early hours of Friday, January 30, after collapsing at home.
A blood sample was taken and she was sent for an x-ray, but was discharged at 5pm that evening with a prescription for iron tablets. She was told to go straight to her GP if there was any relapse over the coming days.
Her situation did not improve over the weekend and, on Monday morning, he took her to their GP practice.
“He asked if the hospital had carried out a brain scan, and when we said no he said that she needed to go back – he said ‘take this note to A&E, she needs a full medical assessment,’” Mr Adekeye recalled.
They arrived just after 11am that morning but the medical assessment unit was full to capacity and she was referred to A&E. However, 12 hours after arriving, she still had not been seen by a doctor.
“A few minutes before 11pm, a nurse came out – she said she was in charge of A&E and that there were over 40 of us waiting over 12 hours (to be seen). She said that all of us could not be attended to because there were not enough doctors.
“I asked what position were we in on the priority list, I saw that we had all been divided into four groups – we were in the third of four sections (fourth being standard cases).”
He said that the nurse did not think that Mrs Adekeye would be seen by a doctor that night, so her husband took her home.
The following morning, he brought her back to the GP practice, where they saw their own GP. He checked her heart and prescribed painkillers – he thought she may have broken a rib in her fall on January 30.
She seemed to be feeling better the next day, Thursday, but that night she collapsed again and fell unconscious.
An ambulance arrived within 45 minutes, but Eniola never regained consciousness, and died just before midnight on February 5.
Dr MacLoughlin said that Mrs Adekeye seemed to have received an appropriate examination on her first admission in January, and that an embolus would have shown up in the chest x-ray that was taken on that date.
“On the second occasion she presented with a letter from her GP – he felt something serious had happened, but was not in a position to make a diagnosis, so he made a recommendation that she be admitted (to the medical assessment unit) for further investigation and observation,” the Coroner said.
“This is all we can expect from the GP, now that we know this (pulmonary embolism) was difficult to diagnose.”
However, he said that the break-down in communication happened when she arrived in A&E, as the ‘clinical impression’ expressed in the GP’s letter – that she was in need of admission for monitoring and investigation – was not treated with any degree of urgency.
“The triage nurse did all the bloods that an experienced doctor would have done, the difficulty is who sees them, and who sees them if the patient leaves the hospital (unseen),” he added.
Solicitor for the HSE, Imelda Tierney, accepted that there had been a ‘difficulty in (staff) resourcing’ on that day, which meant that the anomalies in the blood results were not followed up after Mrs Adekeye left A&E without seeing a doctor on February 2.
Dr Pat Nash, UHG’s Clinical Director, in a letter to the Coroner, acknowledged that the A&E department at the hospital was not fit for purpose, having been constructed in the 1950s.
He said that it was designed to cater for 100 patients, but that the average daily attendance was 176 and, at its busiest, this figure has reached 250.
As with all hospitals in the country, he said, there are difficulties recruiting and retaining staff, which result in serious shortages.
Consultant pathologist, Dr Teresa McHale, said that a pulmonary embolism had occurred over a number of days prior to Mrs Adekeye’s death, which would correspond with her clinical history, but could offer no clear explanation of why she had developed it.
She described the condition as exceptionally unusual for a woman of her age, and would normally be seen in someone who was less mobile.
“She did not have any apparent risk factors for this condition,” Dr McHale added.
In bringing the hearing to a close, the Coroner described it as “a very tragic narrative of what happened to Eniola.”
He recommended that the blood results for any patients that leave A&E be reviewed, and that they be recalled in the event that any anomalies are discovered.
“If this was done, this final and terminal event may not have occurred,” Dr MacLoughlin concluded, before offering his sympathies to Mrs Adekeye’s husband and children on her untimely and unexpected death.
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