Intern who sent photos of seriously-ill patient to on-call doctor was following orders, inquest hears
A medical intern who sent photos of a seriously-ill patient to a doctor-on-call was following instructions, an inquest heard.
The intern-on-call at St James’s Hospital was called to review a private patient who was having difficulty breathing following a thyroidectomy the previous day.
Marian Tracy (60) of Dodsboro Road, Lucan, County Dublin died at St James’s Hospital on May 18 2015. Dublin Coroner’s Court heard she was being kept in hospital over the weekend for observation. Then intern, Dr Michael Dowling qualified from Trinity College in 2014, eleven months before he was called to assist Mrs Tracy on the night of May 15 2015.
She had been taking the blood thinning medication heparin prior to surgery and was administered another blood thinner, clexane, the morning after her surgery. That evening, Mrs Tracy developed neck swelling, difficulty swallowing and breathing and nursing staff became concerned.
They contacted the ENT (ear, nose and throat) registrar-on-call Dr Monica Istovan who asked staff to have the patient reviewed by Dr Dowling, a surgical intern on call within the hospital. He was covering six wards with roughly 25 patients in each that night after working from 8am-5pm during the day. He told the court his immediate concern was haematoma (clots), a ‘well known complication’ following thyroidectomy.
Dr Dowling said his bleeper went off at 10.15pm and he reviewed Mrs Tracy before speaking to Dr Istovan on the phone. She requested photos of the patient and a chest x-ray, he said.
“I gave her all the information I could. With that and all her experience she said it was unlikely to be a haematoma,” Dr Dowling said.
He said the ENT registrar wasn’t worried about clots because there was a drain in place and he felt reassured by this. Asked if he felt exposed by the situation, Dr Dowling replied ‘Yes.’
“I would not have felt comfortable dealing with this on my own,” Dr Dowling said. The advice in situations like this is to consult with senior colleagues, he told the court.
He had difficulty sending the pictures from his phone but they were eventually delivered at 11.08pm and the registrar-on-call replied that she would have to see the patient. While he was attempting to suction Mrs Tracy to ease her breathing she suffered a respiratory arrest. She was pointing to her neck before she became unconscious, the court heard.
“I asked for help because I didn’t know how to open the wound correctly. I was informed the (emergency) team did not know either and I was asked to proceed. I was handed a scalpel which I used to explore the neck,” Dr Dowling said.
He opened the wound, found the clots and evacuated them, before assisting with CPR until the woman’s circulation returned between five and twelve minutes later.
Prof Con Timon, the Consultant Otolaryngologist at St James’s Hospital who performed Mrs Tracy's tyhroidectomy was asked if sending pictures of patients was standard practice. He replied "absolutely not.’ Dr Timon said it was his preference that blood thinning medication be stopped altogether around surgery.
Mrs Tracey died in hospital on May 18 2015.
The cause of death was hypoxicischemic encephalopathy due to respiratory arrest due to airway obstruction, secondary to tracheal compression due to a neck haematoma one day after a thryoidectomy. The inquest was adjourned to hear further evidence on July 12.