Medical staff at a Dublin hospital failed to pick up a classic symptom of a life-threatening condition which killed a woman who was “never sick a day in her life” less than 24 hours after she had been admitted with severe chest pains, an inquest has heard.
Deborah Duffy (50), a married mother of two from Delmere, Enfield, Co Meath, died at Connolly Hospital Blanchardstown on February 4th, 2018 from a hypovolemic shock due to an aortic dissection – where there is a tear in the body’s main artery.
An inquest at Dublin District Coroner’s Court on Monday heard that Ms Duffy was only seen by junior doctors during her stay in the hospital and her condition was not referred to any registrar or consultant.
It also heard evidence that test results showing “critical” levels of a protein in the blood which signifies damage to the heart in the patient which were notified to a nurse were not elevated further.
Counsel for Ms Duffy’s family, Sara Antoniotti SC, said critical decisions about a difficult case were being made by “very junior doctors.”
CT scan
Ms Antoniotti observed that the only way of diagnosing an aortic dissection was by carrying out a CT scan, but none had been done.
Dr Siofra Hearne, a then senior house officer, who examined Ms Duffy said she had considered a number of different diagnoses of the patient’s condition but believed a pulmonary embolism (blood clot) was the most likely cause.
In reply to questions by coroner, Cróna Gallagher, Dr Hearne said her judgement was based on the patient’s clinical signs and the results of a test for checking for blood clotting problems.
The doctor gave evidence that her plan of care was to continue providing antibiotics and pain-relief for the patient and to arrange another echocardiogram.
She accepted that the second echocardiogram was probably not carried out.
Cross-examined by Ms Antoniotti, Dr Hearne acknowledged that she was not aware at the time that a heart murmur was a classic symptom of aortic dissection.
The witness pointed out that the results of various tests on the patient were non-conclusive.
However, Ms Antoniotti observed that the results could be equally due to acute coronary syndrome (a condition with similar symptoms to aortic dissection) as well as a pulmonary embolism.
Asked why she considered a pulmonary embolism the more likely cause, Dr Hearne replied: “That was my clinical diagnosis at the time.”
The witness said she did not know that the results of an assessment known as a Wells score on Ms Duffy meant a pulmonary embolism was unlikely and meant she should have been sent for an immediate CT scan.
Dr Hearne said she would have ordered a scan but not immediately as the patient’s condition was stable when she examined Ms Duffy on a Saturday evening.
The doctor said she believed the scan would be conducted “during working hours” but was unclear if that would be on Sunday or Monday.
Asked why she had not consulted with a more senior doctor, Dr Hearne said the registrar was extremely busy covering the whole hospital, but she would have done so if there had been any change in Ms Duffy’s condition.
Pain levels
Dr Hearne said she could not recall if she was aware that Ms Duffy had described her pain levels as “10 out of 10” on admission to the hospital.
A consultant in emergency medicine Rachel Gilmore, said it was unfortunate that the aortic dissection was not picked up by the hospital.
Dr Gilmore, who did not see or examine Ms Duffy, said she could not say if she would have diagnosed that the patient was suffering from aortic dissection in the circumstances as there were “subtle” tests for the condition.
The inquest heard that Ms Duffy was categorised in triage as a patient who should be examined within one hour by a doctor but it was about one hour and 20 minutes before she was seen by one.
Dr Gilmore said an aortic dissection is an “extremely rare” condition which had been “an elusive diagnosis” in Irish hospitals as there are no clear tests for it.
The inquest heard it has been the subject of a major international campaign to raise awareness about the condition among medical staff.
“A lot of medicine is weighing up probabilities,” Dr Gilmore observed.
She estimated counsel for Connolly Hospital, Rory White BL that, aortic dissection affects around 2-3 individuals per 100,000 population with a mortality rate of up to 25 per cent even when detected.
“We were not expecting it in a 50-year-old woman without any positive medical history,” said Dr Gilmore.
She said nobody had called for a review of Ms Duffy by a more senior doctor “because they weren’t concerned.”
In earlier evidence, the deceased’s husband, David Duffy, said he had called an ambulance for his wife as he thought she was having a heart attack after she complained of severe pains in her chest around midday on February 3, 2018.
Mr Duffy described how she had started to vomit on arrival at the hospital.
He was unhappy as he could not get a doctor to see her in the emergency department but eventually found two medics to have a look at her.
Mr Duffy said his wife was still in “terrible, savage pain” even after she had been given some morphine.
He remained worried about his wife’s condition as he felt she was “putting on a brave face so I could go home.”
The inquest heard he received a call the next morning at 6.30am to come to the hospital straight away as his wife had been found in an unresponsive condition, but she was pronounced dead nine minutes later.
“She was never sick a day in her life,” said Mr Duffy.
He told the coroner that the last words his wife spoke to him were: “I’m not going to die.”
The hearing was adjourned and will resume on Tuesday.
