The family of a 97-year-old woman who died a few days after suffering two broken legs in a fall in a nursing home has expressed disbelief that she was not sent for an x-ray until almost 48 hours after the incident despite being in pain.
A sitting of Dublin District Coroner’s Court heard Breede Twohig experienced an assisted fall while being attended by a healthcare assistant in the Altadore nursing home in Glenageary, Co Dublin on February 13th 2021.
Ms Twohig, a widow and mother of five from Dalkey, Co Dublin, died five days later at St Vincent’s University Hospital where she had been admitted after x-rays confirmed she had suffered two broken femurs (thigh bones).
Fall
Her daughter, Dorothy Twohig, told the inquest that she had been informed by the nursing home on the evening of February 13th, 2021 about the fall.
Ms Twohig said her mother had told her that she was feeling sore and in a lot of pain after the incident.
Ms Twohig said she contacted the nursing home on the morning of February 14th 2021 to get a doctor to check on her mother as she was “in a distressed state” during a video chat.
The witness said Altadore staff had stressed to her that her mother had not suffered a fall but “an assisted fall.”
The inquest heard that Dr Aiden Jennings, an on-call GP, was unable to identify where her pain was.
Dr Jennings did not recommend that she needed an X-ray at the time and prescribed paracetamol for the patient but advised that her condition should be reviewed the following day.
However, Ms Twohig, who was unable to visit the nursing home due to Covid-19 restrictions, said her mother continued to complain about her legs feeling very sore.
Ms Twohig said she felt relieved the following day when Altadore informed her that her mother was being sent for an X-ray and there was no sense of urgency from the nursing home staff about the issue.
She said she was confused when she subsequently received a voicemail at around 7pm advising her to contact Altador as her mother was being brought to the emergency department in St Vincent’s.
She said she was “beyond shock” when the hospital confirmed that her mother had suffered fractures to both her legs.
Ms Twohig said it had never entered her head that her mother might have broken her legs in the fall as she had been assured that her mother’s pain was the result of bruising.
The inquest heard doctors at St Vincent’s decided that it was unsafe to perform surgery on Ms Twohig because of her condition and advanced age.
X-ray
While she recognised that anyone could suffer a fall, Ms Twohig’s daughter said she could not accept that it took 48 hours before her mother was sent for an X-ray.
“It should have happened and it could have saved her life,” she remarked.
Ms Twohig expressed her belief that there would have been “a very different outcome” if the restrictions on visiting nursing homes had not been in place at the time.
“I would have seen my mother and the extent of her injuries rather than relying on a doctor and text messages,” said Ms Twohig.
“I was assured she was being looked at appropriately by professionals,” she added
She understood what an assisted fall was, but it did “not make sense” that someone could suffer fractures as the result of such a fall.
In reply to questions from her own solicitor, Billy Brick, Ms Twohig gave evidence that she had not received much information from the nursing home about her mother’s condition.
Independent
Ms Twohig said her mother was a very robust, fit and healthy woman who had been driving and living independently until she was 92 when she required an operation for cervical stenosis.
However, she said her mother never fully recovered from the operation and had moved to live in the Altadore nursing home.
She had also had surgery 10 years earlier for arthritis which affected both her knees.
A staff nurse at Altadore, Ana Turcu, said she was informed by a healthcare assistant about the assisted fall involving Ms
Twohig about 10 minutes after it happened.
In reply to questions from the coroner, Clare Keane, Ms Turcu said she could not remember if she had gone to check on Ms Twohig but she did not think any major injury could have occurred as the assistant had helped the resident to “go gently onto the floor.”
Altadore’s director of nursing, Rachel Gallogly. told the inquest that all the nursing home’s staff were made aware of its policy on preventing falls as well as receiving training in manual handling and falls prevention.
Questioned by Mr Brick, Ms Gallogly said the nurse in charge of a resident would be responsible for decisions in relation to X-rays.
The inquest heard medical notes from the nursing home recorded that Ms Twohig most likely suffered soft tissue injuries in the fall but that she should be kept under observation for the following 48 hours.
Other medical records show that just before she was brought to hospital it was noted that Ms Twohig was “very pale, sweating and in a lot of pain.”
It was also recorded that the toes on one foot were “a purplish colour” and her legs could not be touched, while she was “screaming in pain.”
In a written statement, consultant surgeon at SVUH, Paul Curtin, said Ms Twohig’s lower legs were “mottled” on arrival, while she also had an elevated white blood cell count and kidney problems.
On the cause of death, Dr Keane said there was no doubt that the fracture to the legs was a factor.
However, the coroner said Ms Twohig also had sepsis and she could not rule out that she had a urinary tract infection prior to the fall which would have also contributed to her death.
She said it was also unclear if Covid-19, with which Ms Twohig had been infected in December 2020, had played any role.
Returning a narrative verdict, Dr Keane expressed condolences to Ms Twohig’s relatives on the death of “an incredible lady.”
