A&E patient 'was priority' but died waiting on trolley
A coroner yesterday said "it did not seem right" that a man who died on a trolley in a Dublin hospital had been prioritised by the emergency department as a serious case but five hours later he had still not been seen by the medical team.
The man, Thomas Brennan (79), of Green Trees Road, Terenure, Dublin, died on a trolley in the A&E department of Tallaght hospital and had been waiting for five hours to be seen by the medical team when he collapsed suddenly, an inquest heard.
Coroner Dr Kieran Geraghty recorded a verdict of death by natural causes as the death was a result of a heart attack, and he accepted there had been no evidence that any treatment could have changed the outcome.
Mr Brennan was rushed to Tallaght Hospital by ambulance on July 21, 2011, after collapsing at home and arrived at 12.30pm.
His main complaint was of severe abdominal pain and he was diagnosed with an inflamed gall bladder.
He was referred for a medical review at 8pm with regard to some other symptoms, which included fluid around the heart.
Mr Brennan was on a trolley and had still not been reviewed by the medical team or admitted when he suffered a sudden collapse at 1am on July 22.
He was pronounced dead almost an hour later, Dublin County Coroner's Court heard.
Acting CEO John O'Connell said Mr Brennan "could not have been in a better or safer place" but accepted that if it was his family he would not want anybody waiting any period of time.
The coroner also expressed alarm that one doctor who reviewed Mr Brennan was working a 36-hour shift. "Anybody having to work for 36 hours without sleep would be at risk."
The coroner asked Mr O'Connell to take action on the matter and to also take action with regard to a practice where some doctors do not read the patient's notes, but rely on a handover from other doctors.
The inquest saw a spat between the hospital's acting CEO and a hospital consultant.
Acting CEO John O'Connell was accused of launching a "personal attack" on Dr Jean O'Sullivan after she criticised the admissions procedures.
The court heard evidence from Dr O'Sullivan, a consultant, that there is an issue with the admissions procedure from the A&E.
"Absolutely no human being should be left on a corridor when they require a bed," she said.
She said that to her knowledge there is no written policy within the hospital which outlines how a patient should be admitted from A&E, despite these guidelines being outlined by the Department of Health, the HSE, the Health Information Quality Authority (HIQA) and "Dr James Reilly himself".
She said the guidelines state that when a patient is referred from the A&E unit to the 'virtual ward', they should be admitted to the hospital, assigned to a team of doctors depending on the care they need, and detailed records of their care kept. The virtual ward is an electronic list of patients who are on corridors and elsewhere around the hospital waiting for a bed.
However, Mr O'Connell said Dr O'Sullivan is "in dispute" with the hospital over working hours and said she was treating patients in her office.
Under questioning by Dr O'Sullivan's barrister, Paul Anthony McDermott, he agreed that she was not breaching her contract and the patients she had treated in her office had been referred to her by the courts system. He also rejected complaints about the admissions system saying that you can’t have “three people introduce a new protocol (of admissions) and not tell anyone about it.”
“It’s absolutely crazy to change a situation that everybody understands is the situation,” said Mr O’Connell, adding that “protocol is clear”.
He also criticised Dr Geraghty for mentioning “18 times” that Mr Brennan had been waiting five hours for admission.
However, Dr Geraghty told Mr O’Connell that that it was “slightly inhuman” to be talking about protocols when they were dealing with people.
Mr Brennan's son Joseph told the court his father kept fit and walked every day.
He said the family felt he was getting good care after his admission to the emergency department and so felt they were able to go home later that evening.
HIQA is currently carrying out an investigation into Tallaght's A&E unit.